Individuals’ Preferences for Esophageal Cancer Screening: A Discrete Choice Experiment

• Published in: Value in health Vol. 23; no. 8; pp. 1087 - 1095
• Main Authors: Peters, Yonne, van Grinsven, Evi, van de Haterd, Michelle, van Lankveld, Daan, Verbakel, Juul, Siersema, Peter D.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.08.2020
• Subjects: Barrett’s esophagus; discrete choice experiment; esophageal cancer; Internal Medicine; patient preferences; screening; discrete choice experiment; Barrett’s esophagus; screening; esophageal cancer; patient preferences
• ISSN: 1098-3015; 1524-4733; 1524-4733
• DOI: 10.1016/j.jval.2020.03.013

The increasing incidence of esophageal adenocarcinoma (EAC) and the dismal prognosis has stimulated interest in the early detection of EAC. Our objective was to determine individuals’ preferences for EAC screening and to assess to what extent procedural characteristics of EAC screening tests predict willingness for screening participation. A discrete choice experiment questionnaire was sent by postal mail to 1000 subjects aged 50 to 75 years who were randomly selected from the municipal registry in the Netherlands. Each subject answered 12 discrete choice questions of 2 hypothetical screening tests comprising 5 attributes: EAC-related mortality risk reduction, procedure-related pain and discomfort, screening location, test specificity, and costs. A multinomial logit model was used to estimate individuals’ preferences for each attribute level and to calculate expected rates of uptake. In total, 375 individuals (37.5%) completed the questionnaire. Test specificity, pain and discomfort, mortality reduction, and out-of-pocket costs all had a significant impact on respondents’ preferences. The average expected uptake of EAC screening was 62.8% (95% confidence interval [CI] 61.1-64.5). Severe pain and discomfort had the largest impact on screening uptake (–22.8%; 95% CI –26.8 to –18.7). Male gender (β 2.81; P < .001), cancer worries (β 1.96; P = .01), endoscopy experience (β 1.46; P = .05), and upper gastrointestinal symptoms (β 1.50; P = .05) were significantly associated with screening participation. EAC screening implementation should consider patient preferences to maximize screening attendance uptake. Based on our results, an optimal screening test should have high specificity, cause no or mild to moderate pain or discomfort, and result in a decrease in EAC-related mortality. •Timely detection of esophageal adenocarcinoma (EAC) and its precursor Barrett’s esophagus could decrease both cancer incidence and mortality. A key factor driving the success or failure of a screening program is individuals’ willingness to undergo the screening test.•The majority of responders expressed willingness to undergo screening for EAC. Test specificity, pain and discomfort, mortality reduction, and out-of-pocket costs all had a significant impact on respondents’ preferences. Individuals are prepared to undergo more burdensome tests if this results in sufficient risk reduction of EAC-related mortality.•EAC screening implementation should consider patient preferences to maximize screening attendance uptake. Understanding how individuals value the attributes of healthcare interventions is important for the design, development, and implementation of effective screening programs.