Department of Radiology and Biomedical Imaging, UCSF, 350 Parnassus, San Francisco, CA, 94117, USA.
Michigan Institute for Clinical & Health Research, Michigan Medicine, Ann Arbor, MI, USA.
Eur Radiol. 2021 Dec;31(12):9139-9149. doi: 10.1007/s00330-021-07982-y. Epub 2021 May 28.
It is unknown how patients prioritize gadolinium-based contrast media (GBCM) benefits (detection sensitivity) and risks (reactions, gadolinium retention, cost). The purpose of this study is to measure preferences for properties of GBCM in women at intermediate or high risk of breast cancer undergoing annual screening MRI.
An institutional reviewed board-approved prospective discrete choice conjoint survey was administered to patients at intermediate or high risk for breast cancer undergoing screening MRI at 4 institutions (July 2018-March 2020). Participants were given 15 tasks and asked to choose which of two hypothetical GBCM they would prefer. GBCMs varied by the following attributes: sensitivity for cancer detection (80-95%), intracranial gadolinium retention (1-100 molecules per 100 million administered), severe allergic-like reaction rate (1-19 per 100,000 administrations), mild allergic-like reaction rate (10-1000 per 100,000 administrations), out-of-pocket cost ($25-$100). Attribute levels were based on published values of existing GBCMs. Hierarchical Bayesian analysis was used to derive attribute "importance." Preference shares were determined by simulation.
Response (87% [247/284]) and completion (96% [236/247]) rates were excellent. Sensitivity (importance = 44.3%, 95% confidence interval = 42.0-46.7%) was valued more than GBCM-related risks (mild allergic-like reaction risk (19.5%, 17.9-21.1%), severe allergic-like reaction risk (17.0%, 15.8-18.1%), intracranial gadolinium retention (11.6%, 10.5-12.7%), out-of-pocket expense (7.5%, 6.8-8.3%)). Lower income participants placed more importance on cost and less on sensitivity (p < 0.01). A simulator is provided that models GBCM preference shares by GBCM attributes and competition.
Patients at intermediate or high risk for breast cancer undergoing MRI screening prioritize cancer detection over GBCM-related risks, and prioritize reaction risks over gadolinium retention.
• Among women undergoing annual breast MRI screening, cancer detection sensitivity (attribute "importance," 44.3%) was valued more than GBCM-related risks (mild allergic reaction risk 19.5%, severe allergic reaction risk 17.0%, intracranial gadolinium retention 11.6%, out-of-pocket expense 7.5%). • Prospective four-center patient preference data have been incorporated into a GBCM choice simulator that allows users to input GBCM properties and calculate patient preference shares for competitor GBCMs. • Lower-income women placed more importance on out-of-pocket cost and less importance on cancer detection (p < 0.01) when prioritizing GBCM properties.
目前尚不清楚患者如何权衡钆基造影剂（GBCM）的获益（检测灵敏度）和风险（不良反应、钆蓄积、费用）。本研究旨在测量在接受年度筛查 MRI 的乳腺癌中危或高危女性中对 GBCM 特性的偏好。
在 4 家机构（2018 年 7 月至 2020 年 3 月）对中危或高危乳腺癌行筛查 MRI 的患者进行机构审查委员会批准的前瞻性离散选择联合调查。参与者接受了 15 项任务，并被要求选择他们更喜欢的两种假设的 GBCM 中的哪一种。GBCM 的特性如下：癌症检测的灵敏度（80-95%）、颅内钆蓄积（1-100 个分子/每 1 亿给药）、严重类过敏反应发生率（1-19/10 万次给药）、轻度类过敏反应发生率（10-1000/10 万次给药）、自付费用（$25-$100）。属性水平基于现有 GBCM 的已发表值。采用分层贝叶斯分析得出属性“重要性”。通过模拟确定偏好份额。
应答率（87%[247/284]）和完成率（96%[236/247]）均非常高。灵敏度（重要性=44.3%，95%置信区间=42.0-46.7%）比 GBCM 相关风险（轻度类过敏反应风险（19.5%，17.9-21.1%）、严重类过敏反应风险（17.0%，15.8-18.1%）、颅内钆蓄积（11.6%，10.5-12.7%）、自付费用（7.5%，6.8-8.3%））更有价值。收入较低的参与者更看重费用，而对灵敏度的重视程度较低（p<0.01）。提供了一个模拟器，可根据 GBCM 属性和竞争情况对 GBCM 偏好份额进行建模。
在接受 MRI 筛查的中危或高危乳腺癌患者中，癌症检测的灵敏度（属性“重要性”，44.3%）比 GBCM 相关风险（轻度类过敏反应风险 19.5%、严重类过敏反应风险 17.0%、颅内钆蓄积 11.6%、自付费用 7.5%）更有价值。
• 在接受年度乳腺 MRI 筛查的女性中，癌症检测灵敏度（属性“重要性”，44.3%）比 GBCM 相关风险（轻度过敏反应风险 19.5%、严重过敏反应风险 17.0%、颅内钆蓄积 11.6%、自付费用 7.5%）更有价值。
• 已将来自四个中心的前瞻性患者偏好数据纳入 GBCM 选择模拟器中，该模拟器允许用户输入 GBCM 属性并计算竞争 GBCM 的患者偏好份额。
• 在优先考虑 GBCM 属性时，收入较低的女性更看重自付费用，而对癌症检测的重视程度较低（p<0.01）。
