Patient Preference and Adherence (Sep 2018)

Women’s preferences, willingness-to-pay, and predicted uptake for single-nucleotide polymorphism gene testing to guide personalized breast cancer screening strategies: a discrete choice experiment

  • Wong XY,
  • Groothuis-Oudshoorn CGM,
  • Tan CS,
  • van Til JA,
  • Hartman M,
  • Chong KJ,
  • IJzerman MJ,
  • Wee HL

Journal volume & issue
Vol. Volume 12
pp. 1837 – 1852

Abstract

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Xin Yi Wong,1 Catharina GM Groothuis-Oudshoorn,2 Chuen Seng Tan,3 Janine A van Til,2 Mikael Hartman,3,4 Kok Joon Chong,5 Maarten J IJzerman,2,6,7 Hwee-Lin Wee1,3 1Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore; 2Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands; 3Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore; 4Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; 5Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; 6Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; 7Victorian Comprehensive Cancer Centre, Melbourne, Australia Background: Single-nucleotide polymorphism (SNP) gene test is a potential tool for improving the accuracy of breast cancer risk prediction. We seek to measure women’s preferences and marginal willingness-to-pay (mWTP) for this new technology. Materials and methods: We administered a discrete choice experiment (DCE) to English-speaking Singaporean women aged 40–69 years without any history of breast cancer, enrolled via door-to-door recruitment with quota sampling by age and ethnicity. DCE attributes comprise: 1) sample type (buccal swab and dried blood spot), 2) person conducting pretest discussion (specialist doctor, non-specialist doctor, and nurse educator), 3) test location (private family clinic, public primary-care clinic, and hospital), and 4) out-of-pocket cost (S$50, S$175, and S$300). Mixed logit model was used to estimate the effect of attribute levels on women’s preferences and mWTP. Interactions between significant attributes and respondent characteristics were investigated. Predicted uptake rates for various gene testing scenarios were studied. Results: A total of 300 women aged 52.6±7.6 years completed the survey (100 Chinese, Malay, and Indian women, respectively). Sample type (P=0.046), person conducting pretest discussion, and out-of-pocket cost (P<0.001) are significantly associated with going for SNP gene testing. Women with higher income and education levels are more willing to pay higher prices for the test. Preferences in terms of mWTP across ethnic groups appear similar, but Chinese women have greater preference heterogeneity for the attributes. Predicted uptake for a feasible scenario consisting of buccal swab, pretest discussion with nurse educator at the hospital costing S$50 is 60.5%. Only 3.3% of women always opted out of the SNP gene test in real life. Reasons include high cost, poor awareness, and indifference toward test results. Conclusion: SNP gene testing may be tailored according to individual preferences to encourage uptake. Future research should focus on outcomes and cost-effectiveness of personalized breast cancer screening using SNP gene testing. Keywords: single-nucleotide polymorphisms, gene testing, personalized breast cancer screening, preci­sion medicine, women’s preferences, willingness-to-pay, predicted uptake, discrete choice experiment

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