Abstract
Objective:To explore how the public and dental professionals would value an orthodontic service for adults by eliciting their willingness-to-pay (WTP), a standardised health economics technique which quantifies ‘strength of preference’ in monetary terms. Despite increasing demand, adults in the UK are only eligible for NHS orthodontic treatment if there is severe dental health or complex multidisciplinary need. Orthodontic services are provided to children aged under 18 years who are eligible by their Index of Orthodontic Treatment Need (IOTN) score. Consequently, many adults who may have a need for treatment as determined by IOTN are unable to access this service.Design:Cross-sectional survey.Setting:General dental practices in North East England and national specialists approached through the British Orthodontic Society (BOS).Participants:Public participants were recruited from general dental practices. Dentists were recruited from local dental lists and members of the BOS.Methods:Participants were asked if they would be willing to pay to see an orthodontic service extended to all adults in England with a qualifying IOTN. Clinical photographs of three malocclusions were presented and maximum WTP in additional tax per household per year was elicited using shuffled payment cards.Results:A total of 205 dentists and 206 public participants were recruited. Pairwise tests showed a statistically significant difference in WTP between the public and professionals for all malocclusions, with the public giving higher valuations. In both groups, the Class III scenario elicited a higher WTP than the class I or II malocclusion. However, when all other factors were controlled for using a regression analysis, the group (public or profession) and the other variables did not significantly influence WTP.Conclusion:The public and professionals were willing to pay for an adult orthodontic service. Due to this variability and unpredictability the allocation of healthcare resources will remain contentious.
Highlights
The demand for adult orthodontic treatment has increased in recent years (Pabari et al, 2011); there is little research investigating how adults value orthodontic care in quality of life or monetary measures (Smith and Cunningham, 2004), with none looking at how the dental profession would value orthodontic care
The public and professionals were willing to pay for an adult orthodontic service
The results show the public and profession were willing to pay for an adult orthodontic service on the National Health Service (NHS) through increased taxation
Summary
The demand for adult orthodontic treatment has increased in recent years (Pabari et al, 2011); there is little research investigating how adults value orthodontic care in quality of life or monetary measures (Smith and Cunningham, 2004), with none looking at how the dental profession would value orthodontic care. Adults may seek orthodontic treatment for several reasons including missed opportunities as a child, orthodontic relapse, cosmetic reasons, indirectly as part of a multidisciplinary. The provision of orthodontics in the taxation-funded National Health Service (NHS) in the UK is governed by the Index of Orthodontic Treatment Need (IOTN), to direct limited NHS resources to those with the highest perceived benefit. Adults are only eligible for treatment on a case-by-case basis if there is a severe dental health issue or complex multidisciplinary need (NHS England, 2015). Even where adult orthodontics is unlikely to be wholly funded, decisions may need to be made as to whether to allow subsidised treatment or including in public or private insurance-based schemes. It is important to quantify the level of benefit, or value, of treatments. Psychosocial benefit is important, benefit can be defined more widely in terms of value, a measure of benefit commonly used in economics
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