Cost satisfaction analysis: a novel patient-based approach for economic analysis of the utility of fixed prosthodontics.

The aim of this study was to apply a novel economic tool (cost satisfaction analysis) to assess the utility of fixed prosthodontics, to review its applicability, and to explore the perceived value of treatment. The cost satisfaction analysis employed the validated Patient Satisfaction Questionnaire (PSQ). Patients with a known prostheses outcome over 1-20 years were mailed the PSQ. Five hundred patients (50·7%) responded. Remembered satisfaction at insertion (initial costs) and current satisfaction (costs in hindsight) were reported on VAS, and the difference calculated (costs with time). Percentage and grouped responses (low, <40%; medium, 40-70%; high, > 70%) were analysed in relation to patient gender, age and willingness to have undergone the same treatment again, and in relation to prostheses age, type, complexity and outcome. Significance was set at P = 0·05. Averages were reported as means ± standard error. Satisfaction with initial costs and costs in hindsight were unrelated to patient gender and age, and prostheses age, type and complexity. Patients with a failure and those who would elect to not undergo the same treatment again were significantly less satisfied with initial costs (P = 0·021, P < 0·001) and costs in hindsight (P = 0·021, P < 0·001) than their counterparts. Patient's cost satisfaction (entire cohort) had significantly improved from 53 ± 1% at insertion to 81 ± 0·9% in hindsight (28 ± 1% improvement, P < 0·001). Patient cost satisfaction had also significantly improved, and the magnitude of improvement was the same within every individual cohort (P = 0·004 to P < 0·001), including patients with failures, and those who in hindsight would not undergo the same treatment again. Low satisfaction was reported by 166 patients initially, but 94% of these reported improvements in hindsight. Fourteen patients (3%) remained dissatisfied in hindsight, although 71% of these would still choose to undergo the same treatment again. Cost satisfaction analysis provided an evaluation of the patient's perspective of the value of fixed prosthodontic treatment. Although fixed prosthodontic treatment was perceived by patients to be expensive, it was also perceived to impart value with time. Cost satisfaction analysis provides a clinically useful insight into patient behaviour.