Vass Caroline M, Rigby Dan, Payne Katherine
Manchester Centre for Health Economics, The University of Manchester, Manchester, UK.
Department of Economics, The University of Manchester, Manchester, UK.
Value Health. 2018 Feb;21(2):219-228. doi: 10.1016/j.jval.2017.07.010. Epub 2017 Sep 1.
The relative benefits and risks of screening programs for breast cancer have been extensively debated.
To quantify and investigate heterogeneity in women's preferences for the benefits and risks of a national breast screening program (NBSP) and to understand the effect of risk communication format on these preferences.
An online discrete choice experiment survey was designed to elicit preferences from female members of the public for an NBSP described by three attributes (probability of detecting a cancer, risk of unnecessary follow-up, and out-of-pocket screening costs). Survey respondents were randomized to one of two surveys, presenting risk either as percentages only or as icon arrays and percentages. Respondents were required to choose between two hypothetical NBSPs or no screening in 11 choice sets generated using a Bayesian D-efficient design. The trade-offs women made were analyzed using heteroskedastic conditional logit and scale-adjusted latent class models.
A total of 1018 women completed the discrete choice experiment (percentages-only version = 507; icon arrays and percentages version = 511). The results of the heteroskedastic conditional logit model suggested that, on average, women were willing-to-accept 1.72 (confidence interval 1.47-1.97) additional unnecessary follow-ups and willing-to-pay £79.17 (confidence interval £66.98-£91.35) for an additional cancer detected per 100 women screened. Latent class analysis indicated substantial heterogeneity in preferences with six latent classes and three scale classes providing the best fit. The risk communication format received was not a predictor of scale class or preference class membership.
Most women were willing to trade-off the benefits and risks of screening, but decision makers seeking to improve uptake should consider the disparate needs of women when configuring services.
乳腺癌筛查项目的相对益处和风险一直存在广泛争议。
量化并调查女性对国家乳腺癌筛查项目（NBSP）的益处和风险的偏好异质性，并了解风险沟通形式对这些偏好的影响。
设计了一项在线离散选择实验调查，以获取公众女性对由三个属性（检测到癌症的概率、不必要后续检查的风险以及自付筛查费用）描述的NBSP的偏好。调查对象被随机分为两项调查中的一项，风险呈现方式要么仅为百分比，要么为图标阵列和百分比。要求受访者在使用贝叶斯D效率设计生成的11个选择集中，在两个假设的NBSP或不进行筛查之间做出选择。使用异方差条件logit模型和尺度调整潜在类别模型分析女性做出的权衡。
共有1018名女性完成了离散选择实验（仅百分比版本 = 507人；图标阵列和百分比版本 = 511人）。异方差条件logit模型的结果表明，平均而言，女性愿意接受每100名接受筛查的女性中额外增加1.72次（置信区间1.47 - 1.97）不必要的后续检查，并愿意为每多检测出一例癌症支付79.17英镑（置信区间66.98 - 91.35英镑）。潜在类别分析表明偏好存在显著异质性，六个潜在类别和三个尺度类别拟合最佳。所接受的风险沟通形式并非尺度类别或偏好类别成员的预测因素。
大多数女性愿意权衡筛查的益处和风险，但寻求提高参与率的决策者在配置服务时应考虑女性的不同需求。
