Estimating the benefits of community water fluoridation using the willingness-to-pay technique: results of a pilot study

Objectives: To estimate the health and non-health effects of fluoridation on well-being using the willingness-to-pay technique. Methods: A pilot study of 100 people was undertaken in which the willingness-to-pay technique was used to estimate the welfare effects of community water fluoridation in the city of Sheffield, in the United Kingdom. In view of the pilot nature of the study, it was decided to use quota sampling based on age and sex rather than random sampling. Reasons for respondents' answers and their previous knowledge of fluoridation were also noted. Results: Sixty-two percent of respondents were in favour of fluoridation, 31% were opposed, and 7% were unsure. Thirty-one respondents refused to answer the willingness-to-pay questions. The mean willingness to pay for those in favour of fluoridation was less than that for those opposed to fluoridation. The main reasons given for opposing fluoridation were its impact on freedom of choice and the desire for pure water. Nineteen percent of the sample held incorrect information on the effects of fluoridation. Conclusions: The study illustrates how a simple referendum can miss important information regarding the intensity of individuals' preferences. An important aspect of the willingness-to-pay technique is its ability to identify 'losers' and quantify their welfare loss. This issue has been ignored by all previous economic evaluations of fluoridation. Further investigation is required to replicate this work on a larger sample of individuals, and to develop the willingness-to-pay technique.