Fazeli Soudabeh, Covarrubias Yesenia, Bassirian Shirin, Cuevas Jordan, Fowler Kathryn, Vodkin Irine, Kono Yuko, Marks Robert, Loomba Rohit, Taouli Bachir, Sirlin Claude, Carlos Ruth
Neuroradiology Fellow, Department of Radiology, University of California San Diego, San Diego, California.
Clinical Research Analyst, Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California.
J Am Coll Radiol. 2022 Apr;19(4):502-512. doi: 10.1016/j.jacr.2022.01.015. Epub 2022 Mar 3.
Abbreviated MRI (AMRI), proposed as an alternative imaging modality for hepatocellular carcinoma screening, provides higher sensitivity than ultrasound. It is, however, unknown how patients weigh the higher sensitivity of AMRI against its higher cost and potentially less desirable testing experience.
To assess patient preferences for hepatocellular carcinoma screening test attributes including sensitivity, false-positive rate, test-related anxiety, cost, and need for intravenous catheterization and contrast use, measured by choice-based conjoint analysis.
This was an ancillary study to two prospective dual-center studies designed to compare the hepatocellular carcinoma detection rates by ultrasound versus AMRI. Of the 135 eligible participants, 106 (median age 63, range 25-85; 56% male) completed the choice-based conjoint analysis survey and were included in this substudy. Participants' preference for individual screening test attributes was assessed using a 12-item, web-based choice-based conjoint analysis survey administered in person at the screening visit. Conjoint analyses software and hierarchical Bayes random-effects logit model were used to calculate the relative importance of each attribute.
The most important attribute driving patient preferences was higher test sensitivity (importance score 39.8%), followed by lower cost (importance score 22.8%) and lower false-positive rate (importance score 19.4%). The overall estimated participants' preference for ultrasound and AMRI were similar when assuming the same specificity for both modalities.
Higher screening test sensitivity and lower cost were the leading patient preference drivers. This study has important implications for understanding patient preferences for specific screening test characteristics as potential determinants of adherence.
简略磁共振成像（AMRI）被提议作为肝细胞癌筛查的一种替代成像方式，其敏感性高于超声。然而，尚不清楚患者如何权衡AMRI较高的敏感性与其较高的成本以及可能不太理想的检查体验。
通过基于选择的联合分析来评估患者对肝细胞癌筛查测试属性的偏好，这些属性包括敏感性、假阳性率、检查相关焦虑、成本以及静脉置管和使用造影剂的需求。
这是两项前瞻性双中心研究的辅助研究，旨在比较超声与AMRI对肝细胞癌的检出率。在135名符合条件的参与者中，106名（中位年龄63岁，范围25 - 85岁；56%为男性）完成了基于选择的联合分析调查，并被纳入该子研究。在筛查就诊时，通过一项基于网络的12项基于选择的联合分析调查，亲自评估参与者对各个筛查测试属性的偏好。使用联合分析软件和分层贝叶斯随机效应逻辑模型来计算每个属性的相对重要性。
驱动患者偏好的最重要属性是较高的检查敏感性（重要性得分39.8%），其次是较低的成本（重要性得分22.8%）和较低的假阳性率（重要性得分19.4%）。当假设两种方式具有相同特异性时，参与者对超声和AMRI的总体估计偏好相似。
较高的筛查测试敏感性和较低的成本是患者偏好的主要驱动因素。这项研究对于理解患者对特定筛查测试特征的偏好作为依从性的潜在决定因素具有重要意义。
