Matro Jennifer M, Ruth Karen J, Wong Yu-Ning, McCully Katen C, Rybak Christina M, Meropol Neal J, Hall Michael J
Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA,
J Genet Couns. 2014 Dec;23(6):1002-11. doi: 10.1007/s10897-014-9724-5. Epub 2014 May 6.
Increasing use of predictive genetic testing to gauge hereditary cancer risk has been paralleled by rising cost-sharing practices. Little is known about how demographic and psychosocial factors may influence individuals' willingness-to-pay for genetic testing. The Gastrointestinal Tumor Risk Assessment Program Registry includes individuals presenting for genetic risk assessment based on personal/family cancer history. Participants complete a baseline survey assessing cancer history and psychosocial items. Willingness-to-pay items include intention for: genetic testing only if paid by insurance; testing with self-pay; and amount willing-to-pay ($25-$2,000). Multivariable models examined predictors of willingness-to-pay out-of-pocket (versus only if paid by insurance) and willingness-to-pay a smaller versus larger sum (≤$200 vs. ≥$500). All statistical tests are two-sided (α = 0.05). Of 385 evaluable participants, a minority (42%) had a personal cancer history, while 56% had ≥1 first-degree relative with colorectal cancer. Overall, 21.3% were willing to have testing only if paid by insurance, and 78.7% were willing-to-pay. Predictors of willingness-to-pay were: 1) concern for positive result; 2) confidence to control cancer risk; 3) fewer perceived barriers to colorectal cancer screening; 4) benefit of testing to guide screening (all p < 0.05). Subjects willing-to-pay a higher amount were male, more educated, had greater cancer worry, fewer relatives with colorectal cancer, and more positive attitudes toward genetic testing (all p < 0.05). Individuals seeking risk assessment are willing-to-pay out-of-pocket for genetic testing, and anticipate benefits to reducing cancer risk. Identifying factors associated with willingness-to-pay for genetic services is increasingly important as testing is integrated into routine cancer care.
预测性基因检测在评估遗传性癌症风险方面的使用日益增加，与此同时，成本分摊做法也在不断增加。关于人口统计学和社会心理因素如何影响个人对基因检测的支付意愿，我们所知甚少。胃肠道肿瘤风险评估项目登记处纳入了根据个人/家族癌症病史前来进行基因风险评估的个体。参与者完成一项基线调查，评估癌症病史和社会心理项目。支付意愿项目包括：仅在保险支付的情况下进行基因检测的意向；自费检测的意向；以及愿意支付的金额（25美元至2000美元）。多变量模型研究了自费支付意愿（与仅在保险支付时相比）以及支付较小金额与较大金额意愿（≤200美元与≥500美元）的预测因素。所有统计检验均为双侧检验（α = 0.05）。在385名可评估的参与者中，少数（42%）有个人癌症病史，而56%有≥1名患结直肠癌的一级亲属。总体而言，21.3%的人仅在保险支付时愿意进行检测，78.7%的人愿意支付。支付意愿的预测因素包括：1）对阳性结果的担忧；2）控制癌症风险的信心；3）认为结直肠癌筛查的障碍较少；4）检测对指导筛查的益处（所有p < 0.05）。愿意支付较高金额的受试者为男性、受教育程度较高、对癌症的担忧较大、患结直肠癌的亲属较少，以及对基因检测的态度更积极（所有p < 0.05）。寻求风险评估的个体愿意自费进行基因检测，并预期对降低癌症风险有益。随着检测被纳入常规癌症护理，识别与基因服务支付意愿相关的因素变得越来越重要。
