Brinkmann Melanie, Diedrich Leonie, Hemmerling Melissa, Krauth Christian, Robra Bernt-Peter, Stahmeyer Jona T, Dreier Maren
Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
Value Health. 2023 Jan;26(1):104-114. doi: 10.1016/j.jval.2022.07.012. Epub 2022 Aug 26.
Colorectal cancer (CRC) screening tests differ in benefits, harms, and processes, making individual informed decisions preference based. The objective was to analyze the preferences of insurees in Germany for characteristics of CRC screening modalities.
A generic discrete choice experiment with 2-alternative choice sets and 6 attributes (CRC mortality, CRC incidence, complications, preparation, need for transportation, and follow-up; 3 levels each) depicting characteristics of fecal testing, sigmoidoscopy, and colonoscopy was generated. Participants completed 8 choice tasks. Internal validity was tested using a within-set dominated pair. Between June and October 2020, written questionnaires were sent to a stratified random sample (n = 5000) of 50-, 55-, and 60-year-old insurees of the AOK (Allgemeine Ortskrankenkasse) Lower Saxony, who had previously received an invitation to participate in the organized screening program including evidence-based information. Preferences were analyzed using conditional logit, mixed logit, and latent-class model.
From 1282 questionnaires received (26% [1282 of 4945]), 1142 were included in the analysis. Approximately 42% of the respondents chose the dominated alternative in the internal validity test. Three heterogeneous preference classes were identified. Most important attributes were preparation (class 1; n = 505, 44%), CRC mortality (class 2; n = 347, 30%), and CRC incidence (class 3; n = 290, 25%). Contrary to a priori expectations, a higher effort was preferred for bowel cleansing (class 1) and accompaniment home (classes 1 and 2).
Internal validity issues of choice data need further research and warrant attention in future discrete choice experiment surveys. The observed preference heterogeneity suggests different informational needs, although the underlying reasons remained unclear.
结直肠癌（CRC）筛查测试在益处、危害和流程方面存在差异，这使得个人基于偏好做出明智决策成为可能。本研究旨在分析德国被保险人对CRC筛查方式特征的偏好。
设计了一项通用的离散选择实验，包含二选一的选择集以及6个属性（CRC死亡率、CRC发病率、并发症、准备工作、交通需求和后续跟进；每个属性分3个级别），这些属性描述了粪便检测、乙状结肠镜检查和结肠镜检查的特征。参与者完成8项选择任务。使用组内占优对来测试内部效度。2020年6月至10月期间，向德国下萨克森州AOK（Allgemeine Ortskrankenkasse，地方医疗保险机构）的50岁、55岁和60岁被保险人的分层随机样本（n = 5000）发送了书面问卷，这些被保险人此前已收到参加有组织筛查计划的邀请，其中包括基于证据的信息。使用条件logit模型、混合logit模型和潜在类别模型分析偏好。
共收到1282份问卷（占4945份的26%[1282/4945]），其中1142份纳入分析。在内部效度测试中，约42%的受访者选择了占优选项。确定了三个异质性偏好类别。最重要的属性是准备工作（第1类；n = 505，44%）、CRC死亡率（第2类；n = 347，30%）和CRC发病率（第3类；n = 290，25%）。与先验预期相反，对于肠道清洁（第1类）和送回家（第1类和第2类），人们更倾向于付出更多努力。
选择数据的内部效度问题需要进一步研究，并且在未来的离散选择实验调查中值得关注。观察到的偏好异质性表明存在不同的信息需求，尽管其潜在原因尚不清楚。
