| Objective This study incorporates patients’ preferences into the selection of orthodontic treatment options by identifying the influence of different factors on orthodontic patients’ behavioural decision-making.It provides a reference for decision making to provide accurate treatment options,improve patient compliance and satisfaction,and improve service quality.Methods Based on a discrete choice experimental（DCE）approach,literature review and expert consultation were used to determine the attributes and their levels for this study.The study design was conducted using D-efficiency with the aid of DCE specific software Ngene1.2,and a total of 8 pairs of choice sets were created.A face-to-face questionnaire was administered to orthodontic patients in a tertiary dental specialty hospital in Anhui Province from September 2019 to March 2020.Data entry was performed using Excel 2013 and statistical analysis was performed by constructing conditional logit models and mixed logit models by Stata16.0 software to assess patients’ preference for orthodontic options.Results 1.A total of four study attributes were ultimately included in this study（follow-up interval;comfort degree of appliance;aesthetic degree of appliance;treatment cost）.2.A total of 523 orthodontic patients were surveyed and the mean age of the patients surveyed was 20.47（± 6.29）years.Patients’ oral health is generally poor.3.The results of the mixed logit regression model showed that all four attributes included in this study were statistically significant.Time between follow-up interval,comfort,aesthetics and treatment cost all had a significant effect on patient choice of orthodontic solution.Patients prefer an orthodontic option with a 2-month follow-up interval,very good comfort,very good aesthetics and low treatment costs most.4.Patients considered treatment cost to be the most important of the four treatment attributes（41.62%）,followed by appliance comfort（30.19%）and appliance aesthetics（25.65%）,with the time between follow-up appointments being relatively the least important at 2.54%.5.The willingness to pay results showed that patients were willing to pay ￥16,500,￥13,000 and ￥21,800 more in order to upgrade their appliances from slightly poor to general,better and very good comfort respectively.6.There was heterogeneity in orthodontic treatment options for patients of different age groups.There was no heterogeneity in patients’ preference for orthodontic treatment options by gender,education level,marital status and annual household income.7.The results of the scenario analysis showed that changing the level of single appliance aesthetics had the greatest impact on the probability of patients choosing an orthodontic solution compared to the baseline level,increasing the level of appliance aesthetics from slightly poor to general,good and very good increased the probability of patients choosing by 61.25%,50.85% and 73.42% respectively.Conclusions and Recommendations The discrete choice experiment is a valid tool for measuring orthodontic patient preference for treatment options.Economic factors were the primary factor influencing orthodontic patients’ choice of treatment options,while comfort and aesthetics of appliances were also important factors influencing patients’ choice of orthodontic options,with an relatively weak effect on patient choice of the follow-up interval.There is heterogeneity in population preferences between orthodontic patients,with underage patients having a higher preference for appliances that are generally comfortable and adult patients most preferring treatment options with very good aesthetics.The orthodontist should work with the patient to develop a better orthodontic solution based on the patient’s population-based characteristics and selection preferences.Improving the aesthetics of the appliances has the greatest impact on the probability of patient choice.Reducing the cost of treatment,producing relatively inexpensive appliances and improving the comfort of appliances are important in increasing orthodontic patients’ attendance and adherence to treatment.In addition,it is recommended that oral health promotion in the community and schools should be strengthened and measures to improve the oral health status of the population should be implemented,especially among the underage population. |
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