Factors affecting willingness to pay for NHS-based orthodontic treatment

Padhraig S Fleming; Fiorella Colonio-Salazar; Andrea Waylen; Martyn Sherriff; Donald Burden; Ciaran O Neill; Andy Ness; Jonathan Sandy; Tony Ireland

doi:10.1038/s41415-022-3878-6

Factors affecting willingness to pay for NHS-based orthodontic treatment

Br Dent J. 2022 Jan 28. doi: 10.1038/s41415-022-3878-6. Online ahead of print.

Authors

Padhraig S Fleming¹, Fiorella Colonio-Salazar², Andrea Waylen³, Martyn Sherriff⁴, Donald Burden⁵, Ciaran O Neill⁵, Andy Ness⁶, Jonathan Sandy⁷, Tony Ireland⁸

Affiliations

¹ Professor of Orthodontics, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. padhraig.fleming@gmail.com.
² Lecturer, Queen Mary University of London, London, UK.
³ Senior Lecturer in Social Sciences, School of Oral and Dental Sciences, University of Bristol, Bristol, UK.
⁴ Visiting Professor, Dental Material Science, University of Bristol, Bristol, UK.
⁵ Professor of Orthodontics, Queen´s University Belfast, Belfast, UK.
⁶ Professor of Epidemiology, Bristol Dental School, Bristol, UK.
⁷ Professor of Orthodontics, Child Dental Health, Bristol Dental School, Bristol, UK.
⁸ Professor of Orthodontics, Bristol Dental School, University of Bristol, Bristol, UK.

PMID: 35091691
DOI: 10.1038/s41415-022-3878-6

Abstract

Objective To assess factors affecting willingness to pay for orthodontic treatment.Methods An online discrete choice experiment and willingness to pay study was conducted on a convenience sample of 250 participants aged 16 and above over a four-month period. Participants completed a series of stated-preference tasks, in which they viewed choice sets with two orthodontic treatment options involving different combinations of attributes: family income; cost to patient; cause of problem; prevention of future problems; age; severity of the problem; and self-esteem/confidence.Results Family income, cost to patient, cause of the problem, age and self-esteem/confidence were the most important attributes influencing participants' decisions to have orthodontic treatment. Participants felt that free NHS-based orthodontic provision should be prioritised for those under 18, regardless of family income, for those with developmental anomalies, particularly where self-esteem and confidence are affected, with younger participants (aged 16-24 years) strongly preferring full NHS funding for those under 18 years old (p = 0.007, 95% CI: 0.57-0.09) who dislike smiling in public, especially where self-esteem and confidence are impaired (p = 0.002, 95% CI: 0.16-0.71). Participants with high annual income had the highest preference for the NHS to fund treatment regardless of income (p = 0.02, 95% CI: 0.13-1.47) and placed an onus on addressing developmental anomalies (p = 0.004, 95% CI: 0.22-1.15). In total, 159 (63.6%) of those who would undergo treatment were willing to pay for it, with the majority (88%) open to paying up to £2,000 and only three participants stating the NHS should not contribute towards the cost of orthodontic treatment.Conclusions Based on this pilot study, key factors influencing the decision to undergo treatment included family income, cost, the aetiology of malocclusion, age and self-esteem/confidence. It was felt that free NHS-based treatment should be given priority where self-esteem and confidence are impaired among young people. Further research to inform the priorities underpinning the provision of dental care and orthodontic treatment within the NHS is required.