Wang Kailu, Shum Ho-Man, Yam Carrie Ho-Kwan, Tang Shangfeng, Li Chunyan, Wu Yushan, Wong Eliza Lai-Yi, Yeoh Eng-Kiong
Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Pharmacoecon Open. 2025 Sep 4. doi: 10.1007/s41669-025-00598-8.
This study aims to quantify the preference of adults below 50 years of age for fecal immunochemical test (FIT) options as screening for colorectal cancer (CRC) and its disparities across different subgroups.
A discrete choice experiment (DCE) was conducted among adults aged < 50 years old in Hong Kong. A mixed logit model and latent class model were used to estimate their preference, taking into account their preference heterogeneity. Marginal willingness-to-pay for changes in the attribute levels was also estimated.
A total of 408 participants with valid responses were included for analysis. The outcomes showed 5.2% of participants would consistently reject all the 20 FIT alternatives presented to them in the DCE survey. Mortality reduction in FIT programs was deemed as the most important attribute, followed by testing frequency, early detection likelihood, familiar physician, and reduction of false positive rate. The FIT acceptance was sensitive to the change of out-of-pocket payment amount. The latent class model showed participants with different ages, educational level, and self-reported health status would have different preferences for FIT attribute levels.
The study showed that most adults below 50 years old would be willing to consider receiving FIT if suitable testing options are available. They are more sensitive to changes in mortality reduction than changes in CRC early detection likelihood, suggesting the former is more important in information dissemination. The impact of out-of-pocket payments for FIT on its acceptance suggests that the introduction of financial subsidies can be considered to improve screening acceptance. The preference heterogeneity highlights the importance of healthcare professionals' understanding of people's values and preferences for decision-making.
本研究旨在量化50岁以下成年人对粪便免疫化学检测（FIT）作为结直肠癌（CRC）筛查方法的偏好及其在不同亚组间的差异。
在香港对50岁以下成年人进行了一项离散选择实验（DCE）。使用混合逻辑模型和潜在类别模型来估计他们的偏好，同时考虑到偏好的异质性。还估计了属性水平变化的边际支付意愿。
共有408名有有效回复的参与者纳入分析。结果显示，5.2%的参与者会一致拒绝DCE调查中向他们展示的所有20种FIT替代方案。FIT项目中的死亡率降低被认为是最重要的属性，其次是检测频率、早期发现可能性、熟悉的医生以及假阳性率的降低。FIT的接受度对自付费用金额的变化很敏感。潜在类别模型显示，不同年龄、教育水平和自我报告健康状况的参与者对FIT属性水平有不同的偏好。
该研究表明，如果有合适的检测选项，大多数50岁以下的成年人愿意考虑接受FIT。他们对死亡率降低变化的敏感度高于对CRC早期发现可能性变化的敏感度，这表明前者在信息传播中更重要。FIT自付费用对其接受度的影响表明，可以考虑引入财政补贴以提高筛查接受度。偏好的异质性凸显了医疗保健专业人员了解人们的价值观和偏好以进行决策的重要性。
