INDIVIDUALS' PREFERENCES FOR ESOPHAGEAL CANCER SCREENING STRATEGIES: A DISCRETE CHOICE EXPERIMENT

Aims:

Screening for esophageal adenocarcinoma (EAC) and its precursor Barrett's esophagus could possibly reverse the increasing incidence of EAC. Our objective was to determine individuals' preferences for EAC screening and to assess to what extent procedural characteristics of screening tests predict willingness for screening participation.

Methods:

A discrete choice experiment questionnaire was sent by mail to 1000 individuals aged 50 to 75 years who were randomly selected from the municipal registry of Nijmegen. Each subject answered 12 discrete choice questions of two screening tests comprised of five attributes: EAC-related mortality risk reduction, procedure-related pain and discomfort, location, test specificity, and costs. A multinomial logit model was used to estimate preferences for each attribute level and to calculate relative importance scores of each attribute and expected uptake rates.

Results:

In total, 375 patients (37.5%) completed the questionnaire. Test specificity had the highest impact on respondents' preferences, accounting for 27.2%, followed by pain and discomfort (26.8%), and mortality reduction (24.6%). The average expected uptake of EAC screening was 62.8% (95% CI:61.1 – 64.5). Heavy pain and discomfort had the largest impact on screening uptake (-22.8%;95% CI:-26.8 – 18.7)(Table 1). Male gender (OR:1.86;P =.005), health status (OR:0.18;P =.03), endoscopy experience (OR:2.07;P =.02), and upper gastrointestinal symptoms (OR:1.13;P =.001) were significantly associated with screening participation.

Tab. 1:

Effects of changing the screening program characteristics on the probability of participation in esophageal cancer screening

Attributes	Impact of attribute levels on probability of screening participation (%) (* indicates p<.05)
Mortality reduction (per 1000 screened individuals)	2 per 1000 Reference	3 per 1000 +5.8%*	4 per 1000 +14.0%*	5 per 1000 +17.8%*
Pain and discomfort	No pain/discomfort Reference	Mild pain/discomfort -1.5%	Moderate pain/discomfort -2.0%	Heavy pain/discomfort -22.8%*
Out-of-pocket costs (€)	Costs: € 0 Reference	Costs: € 25 -6.2%*	Costs: € 50 -10.3%*	Costs: € 75 -16.7%*
Specificity (%)	Specificity: 50% Reference	Specificity: 70% -3.2%	Specificity: 90% +12.7%*	Specificity: 100% +17.1%*

Conclusions:

Understanding individuals' preferences for EAC screening tests helps to further design the optimal screening modality by selecting the attributes that maximize attendance. Based on our results, an optimal screening test should have a high specificity, cause no or low to moderate pain or discomfort and result in a decrease in EAC-related mortality.