Preferences of Parents To Avoid Oral Health Outcomes In Children: Results of A Discrete Choice Experiment

OBJECTIVES: Economic evaluation of oral health interventions requires a valuation of potential health outcomes. This is challenging for interventions targeted at children due to a lack of measures of oral health outcome for children. We propose direct elicitation of oral health states by parents of children. We aim to obtain willingness-to-pay (WTP) values for preventing oral ill-health in children to inform economic modelling, using a discrete choice experiment (DCE). METHODS: We characterised oral health problems using type of tooth and severity in decay. This was informed by economic model planning, clinical advice and a focussed literature review. Pretesting was conducted, followed by two surveys administered online to UK general population panel. The DCE study included a cost attribute to estimate respondents' WTP to avoid specific oral health problems. A Bayesian D-efficient design was employed using estimates from the first survey as informative priors in the final statistical design. RESULTS: Attributes were defined by type of tooth affected (baby and permanent) and attributes levels were: no problem, decay without pain, decay with pain and tooth requiring removal. Coefficients and standard errors from the first survey (N=257), were used to inform the second survey (N=1050). Conditional logit model was fitted to the data. Avoiding problems in permanent teeth was valued much higher than baby teeth by the parents. They were willing to pay more to prevent tooth decay in baby teeth than avoiding baby tooth loss. Avoiding decay with pain in the child's permanent tooth generated the highest WTP (mean £417; 95% CI £373 to £465) followed by removal of permanent tooth (mean £415; £373 to £459). Avoiding decay with pain in baby tooth obtained a WTP of £107 (95% CI: £70 to £141). CONCLUSIONS: Results demonstrate that parents have stronger preferences to avoid problems with permanent compared to baby teeth.