Health Economics and Policy, Vienna University of Economics and Business, Vienna, Austria; Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore; Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Value Health. 2020 Sep;23(9):1246-1255. doi: 10.1016/j.jval.2020.06.004. Epub 2020 Aug 15.
Low uptake of cancer screening services is a global concern. Our aim was to understand factors that influence the screening decision, including screening and treatment subsidies and a gain-frame message designed to present screening as a win-win.
We analyzed preferences for mammography and Pap smear among women in Singapore by means of discrete choice experiments while randomly exposing half of respondents to a gain-framed public health message promoting the benefits of screening.
Results showed that the message did not influence stated uptake, and given the levels shown, respondents were influenced more by treatment attributes, including effectiveness and out-of-pocket cost should they test positive, than by screening attributes, including the offer of a monetary incentive for screening. Respondents also underestimated the survival chances of screen-detected breast and cervical cancers.
Combined, these findings suggest that correcting misconceptions about screen-detected cancer prognosis or providing greater financial protection for those who test positive could be more effective and more cost-effective than subsidizing screening directly in increasing screening uptakes.
癌症筛查服务利用率低是一个全球性问题。本研究旨在了解影响筛查决策的因素，包括筛查和治疗补贴以及采用增益框架信息，将筛查描述为双赢。
我们通过离散选择实验分析了新加坡女性对乳房 X 光检查和巴氏涂片检查的偏好，并随机向一半受访者展示了一则增益框架的公共卫生信息，以宣传筛查的益处。
结果表明该信息并未影响筛查意愿，而且考虑到显示的水平，受访者更多地受到治疗属性的影响，包括如果检测呈阳性的有效性和自付费用，而不是筛查属性，包括筛查的货币激励。受访者还低估了筛查发现的乳腺癌和宫颈癌的生存机会。
综合这些发现表明，纠正对筛查发现的癌症预后的误解，或者为那些检测呈阳性的人提供更大的财务保护，可能比直接补贴筛查更有效、更具成本效益，从而提高筛查率。
