Disponibilidade a pagar por procedimentos odontológicos : estudo bibliométrico e análise de fatores associados

Abstract

Economic evaluations play an important role so that resources can be more rationally and efficiently used and should be directed to the needs and attributes that matter most to service users. Among the methods to assess the valuation of health in relation to dental treatments, the willingness to pay (WTP) stands out, and represents the strength of an individual's preference for a given intervention and the maximum amount of money that would be sacrificed for that intervention. intervention. The aim of this study was to carry out a bibliometric study of WTP in Dentistry and to evaluate the WTP for dental procedures and its associated factors. Initially, a bibliometric study was carried out, in which a systematic search was used in order to identify publications that analyzed WTP in the field of dentistry. Searches were conducted in PubMed, Web of Science and Scopus databases. The studies were selected by two independent researchers, and inconsistencies were decided through deliberation between them. Then, a quantitative and analytical study was carried out, with a cross-sectional observational design on WTP due to dental procedures. 280 individuals participated in this study, using digital forms on the Google Workspace platform (GoogleForms), collecting socioeconomic data, burden of oral disease, oral health complaints, preference for attributes of oral health care, in addition to willingness to pay for dental procedures. Initially, a descriptive analysis of the data was performed, obtaining the absolute frequency of the variables, the mean, the median and the standard deviation. Multiple regressions were generated between the independent variables and WTP for dental procedures, considering a p value <0.05 and a 95% confidence interval as significant. For bibliometric analysis, 67 studies were included, most of them were published between 2021 and 2022 (n=20, 30%), whose study location was the United Kingdom (n=19, 28%) and which used the contingent valuation technique (n=46, 70%). For the observational study, the sample consisted by individuals, mostly female (63.9%), with higher education level (93.6%), family income of more than 5 minimum wages (39,3%), users of the service or general public (64.3%), without oral health complaints (70%) and who present a burden of oral disease with up to 2 oral health problems. The results showed that, for socioeconomic factors, income and insertion level in Dentistry were the variables that were associated with a higher WTP. Compared to people with an income of 5 minimum wages (MW) or more, individuals with lower income (up to 2 MW) had lower WTP for routine appointment (PR=0.73, p<0.01), anterior tooth restoration (PR=0.78, p<0.01), simple extraction (PR=0.76, p<0.01) and prophylaxis (PR=0.81, p<0.01). Compared to dentistry professionals and students, people not connected to dentistry had lower WTP for anterior tooth restoration (PR=0.77, p<0.01), extraction (PR=0.77, p<0.01) and prophylaxis (PR=0.74, p<0.01). Regarding the attributes of choice, for a package of basic procedures, consisting on routine appointment, anterior tooth restoration, extraction and prophylaxis, it was observed that a higher WTP was associated with the choice of scheduled consultation or appointment reflected in higher WTP (PR=1.53, p<0.01), performed by a specialist dentist (PR=1.53, p<0.01) or general practitioner (PR=1.53, p<0.01). For a package of more complex procedures (basic procedures + root canal treatment + prosthetic rehabilitation), higher WTP was observed among individuals who would choose treatment at a private clinic without health insurance (PR=1.19, p<0.01) and consultation by appointment (PR=1.17, p<0.01). The bibliometric study showed that the number of studies on WTP in the area of dentistry has increased and that, regarding the geographic distribution of studies, there is a concentration of these studies in developed countries such as the United Kingdom and Canada. There is also a tendency for publications in some areas of dentistry, such as oral rehabilitation, orthodontics and preventive and social dentistry. About the most relevant factors for the choice of users, family income and level of insertion in dentistry were highlighted. It also observed that the attributes most valued by service users were professional training and the type of appointment.