评估女性对乳腺癌筛查的偏好及支付意愿：一种离散选择实验方法。

Assessing Women's Preference and Willingness to Pay for Breast Cancer Screening: A Discrete Choice Experiment Approach.

作者信息

Tahal Reyhane, Nahvijou Azin, Sari Ali Akbari, Daroudi Rajabali

机构信息

Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Cancer Research Center of Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Value Health Reg Issues. 2025 Jul;48:101110. doi: 10.1016/j.vhri.2025.101110. Epub 2025 Mar 24.

DOI:10.1016/j.vhri.2025.101110

PMID:40132432

Abstract

OBJECTIVES

This study aimed to explore women's preferences regarding breast cancer screening using a discrete choice experiment and willingness-to-pay analysis.

METHODS

A discrete-choice experiment was conducted among 255 women aged 40 to 65 years who were referred to health centers in Tehran city. The experiment included attributes such as screening methods (clinical examination and mammography), number of deaths prevented, possibility of misdiagnosis and unnecessary biopsy, screening intervals, and cost of the screening test. A conditional logit model was used to estimate preferences, and willingness-to-pay values were derived from the model coefficients.

RESULTS

Women revealed a strong preference for mammography over clinical examination(odds ratio [OR] 1.73; 95% CI 1.47-2.04; P < .001). Compared with 1 death prevented per 1000 women, the ORs for 3 and 6 deaths prevented per 1000 women were 18.1 (95% CI 12.72-25.75; P < .001) and 74.48 (95% CI 49.41-112.27; P < .001), respectively. The ORs for misdiagnosis and unnecessary biopsy rates of 10 of 100 people were 0.006 (95% CI 0.003-0.012; P < .001). Preferences for screening intervals varied, with a higher preference for screening every 4 years (OR 2.77; 95% CI 1.73-4.43; P < .001) compared with annual screening. The cost was also a significant factor, with a decrease in the odds of choosing a screening option as the cost increased (OR 0.139; 95% CI 0.1396-0.1399; P = .001).

CONCLUSIONS

This study provides valuable insights into women's preferences for breast cancer screening in Iran.

摘要

目的

本研究旨在使用离散选择实验和支付意愿分析来探索女性对乳腺癌筛查的偏好。

方法

对255名年龄在40至65岁之间、被转诊至德黑兰市健康中心的女性进行了离散选择实验。该实验包括筛查方法（临床检查和乳房X光检查）、预防死亡人数、误诊和不必要活检的可能性、筛查间隔以及筛查测试成本等属性。使用条件logit模型来估计偏好，并从模型系数中得出支付意愿值。

结果

与临床检查相比，女性对乳房X光检查表现出强烈偏好（优势比[OR]1.73；95%置信区间1.47 - 2.04；P <.001）。与每1000名女性预防1例死亡相比，每1000名女性预防3例和6例死亡的OR分别为18.1（95%置信区间12.72 - 25.75；P <.001）和74.48（95%置信区间49.41 - 112.27；P <.001）。每100人中误诊和不必要活检率为10时的OR为0.006（95%置信区间0.003 - 0.012；P <.001）。对筛查间隔的偏好各不相同，与每年筛查相比，每4年筛查一次的偏好更高（OR 2.77；95%置信区间1.73 - 4.43；P <.001）。成本也是一个重要因素，随着成本增加，选择筛查选项的几率降低（OR 0.139；95%置信区间0.1396 - 0.1399；P =.001）。