Discrete choice analysis of preferences for dental prostheses
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Background: Tooth loss has a negative impact on patients’ general health and wellbeing. Dental prostheses can restore oral function, aesthetics and improve oral health related quality of life. Preferences for dental prostheses cannot be fully captured using existing clinical studies and questionnaires. Discrete choice experiment (DCE) is a novel method in health economics to elicit people’s preference for treatments and it allows the researcher to integrate all aspects relevant to treatment into evaluation and measurement of interrelationship between factors. The aim of this PhD thesis is to use a mixed method of DCE and qualitative interviews to analyse dentists and patient’s preferences for dental prosthesis choices in replacing missing teeth. Methods: Discrete choice experiment questionnaires were developed, describing dental prosthdontic treatments in multi-dimensions, including outcome, process and economic factors. Survey and analysis using the questionnaires were conducted with dentists and patients in Edinburgh. Qualitative interviews with Edinburgh dentists and patients were carried out to derive factors to aid the DCE questionnaire design and provide in-depth understanding of DCE results. Systematic reviews were performed to summarise existing evidence on prosthesis evaluation in traditional quantitative studies and perception of prostheses in qualitative interviews. The current application of DCEs in dentistry was also systematically reviewed. Results: Treatment longevity was identified as the most important factor for dentists and patients’ treatment decisions of anterior missing tooth replacements, followed by appearance and chewing function. Dentists put more value on fixation/comfort and treatment procedure than patients. Patients cared about cost of treatment whereas dentists were relatively insensitive. Gender, age and treatment experience significantly influenced patients’ preference for treatment characteristics. Dental implant supported crown was preferred by dentists, whereas patients gave higher utility to traditional prosthodontic treatments. The monetary benefit of fixed dental prostheses ranged from £1856 -£3848 for patients, far exceeding their willingness-to-pay (WTP), which was £120 - £240. Dentists were willing to pay £600-£3000, more than the perceived benefit £503 to £1649. Qualitative study identified the above factors and provided interpretation of DCE results. Problems in the dental care system related to referral and training for dental implant treatments were raised. Discussion: This thesis is the first DCE application in dentistry evaluating and comparing dentists and patients preferences for missing tooth replacements. Dentists and patients’ preferences were elicited qualitatively and qualitatively integrating multidimensional factors. Patients’ preference for treatments, monetary benefit and WTP were demonstrated to be different from dentists’. Treatment benefits exceeded patients WTP for fixed dental prostheses.