Abstract
Background: Lung cancer screening can reduce cancer mortality. Most implementation studies focus only on low-dose computed tomography (LDCT) and clinical attributes of screening and do not include preferences of potential participants. In this study we evaluated the perceived value of screening programs based on LDCT, breath analysis (BA), or blood biomarkers (BB) according to the perspective of the target population. Methods: A multi-criteria decision analysis framework was adopted. The weights of seven attributes of screening (sensitivity, specificity, radiation burden, duration of screening process, waiting time until results are communicated, location of screening, and mode of screening) were obtained from an earlier study that included a broad sample from the Netherlands. Performance data for the screening modalities was obtained from clinical trials and expert opinion. Parameter uncertainty about clinical performances was incorporated probabilistically, while heterogeneity in preferences was analyzed through subgroup analyses. Results: The mean overall values were 0.58 (CI: 0.57 to 0.59), 0.57 (CI: 0.56 to 0.59), and 0.44 (CI: 0.43 to 0.45) for BB, BA, and LDCT, respectively. Seventy-seven per cent of respondents preferred BB or BA. For most subgroups, the overall values were similar to those of the entire sample. BA had the highest value for respondents who would have been eligible for earlier screening trials. Discussion: BB and BA seem valuable to participants because they can be applied in a primary care setting. Although LDCT still seems preferable given its strong and positive evidence base, it is important to take non-clinical attributes into account to maximize attendance.
| Original language | English |
|---|---|
| Pages (from-to) | 1269-1277 |
| Number of pages | 9 |
| Journal | Value in health |
| Volume | 21 |
| Issue number | 11 |
| DOIs | |
| Publication status | Published - 1 Nov 2018 |
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Keywords
- multicriteria decision analysis
- public preferences
- subgroup analysis
- uncertainty
- lung cancer screening
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Assessing Lung Cancer Screening Programs under Uncertainty in a Heterogeneous Population. / Broekhuizen, Henk (Corresponding Author); Groothuis-Oudshoorn, Catharina G.M.; Vliegenthart, Rozemarijn; Groen, Harry J.M.; IJzerman, Maarten J.
In: Value in health, Vol. 21, No. 11, 01.11.2018, p. 1269-1277.Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Assessing Lung Cancer Screening Programs under Uncertainty in a Heterogeneous Population
AU - Broekhuizen, Henk
AU - Groothuis-Oudshoorn, Catharina G.M.
AU - Vliegenthart, Rozemarijn
AU - Groen, Harry J.M.
AU - IJzerman, Maarten J.
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Background: Lung cancer screening can reduce cancer mortality. Most implementation studies focus only on low-dose computed tomography (LDCT) and clinical attributes of screening and do not include preferences of potential participants. In this study we evaluated the perceived value of screening programs based on LDCT, breath analysis (BA), or blood biomarkers (BB) according to the perspective of the target population. Methods: A multi-criteria decision analysis framework was adopted. The weights of seven attributes of screening (sensitivity, specificity, radiation burden, duration of screening process, waiting time until results are communicated, location of screening, and mode of screening) were obtained from an earlier study that included a broad sample from the Netherlands. Performance data for the screening modalities was obtained from clinical trials and expert opinion. Parameter uncertainty about clinical performances was incorporated probabilistically, while heterogeneity in preferences was analyzed through subgroup analyses. Results: The mean overall values were 0.58 (CI: 0.57 to 0.59), 0.57 (CI: 0.56 to 0.59), and 0.44 (CI: 0.43 to 0.45) for BB, BA, and LDCT, respectively. Seventy-seven per cent of respondents preferred BB or BA. For most subgroups, the overall values were similar to those of the entire sample. BA had the highest value for respondents who would have been eligible for earlier screening trials. Discussion: BB and BA seem valuable to participants because they can be applied in a primary care setting. Although LDCT still seems preferable given its strong and positive evidence base, it is important to take non-clinical attributes into account to maximize attendance.
AB - Background: Lung cancer screening can reduce cancer mortality. Most implementation studies focus only on low-dose computed tomography (LDCT) and clinical attributes of screening and do not include preferences of potential participants. In this study we evaluated the perceived value of screening programs based on LDCT, breath analysis (BA), or blood biomarkers (BB) according to the perspective of the target population. Methods: A multi-criteria decision analysis framework was adopted. The weights of seven attributes of screening (sensitivity, specificity, radiation burden, duration of screening process, waiting time until results are communicated, location of screening, and mode of screening) were obtained from an earlier study that included a broad sample from the Netherlands. Performance data for the screening modalities was obtained from clinical trials and expert opinion. Parameter uncertainty about clinical performances was incorporated probabilistically, while heterogeneity in preferences was analyzed through subgroup analyses. Results: The mean overall values were 0.58 (CI: 0.57 to 0.59), 0.57 (CI: 0.56 to 0.59), and 0.44 (CI: 0.43 to 0.45) for BB, BA, and LDCT, respectively. Seventy-seven per cent of respondents preferred BB or BA. For most subgroups, the overall values were similar to those of the entire sample. BA had the highest value for respondents who would have been eligible for earlier screening trials. Discussion: BB and BA seem valuable to participants because they can be applied in a primary care setting. Although LDCT still seems preferable given its strong and positive evidence base, it is important to take non-clinical attributes into account to maximize attendance.
KW - multicriteria decision analysis
KW - public preferences
KW - subgroup analysis
KW - uncertainty
KW - lung cancer screening
UR - http://www.scopus.com/inward/record.url?scp=85056518605&partnerID=8YFLogxK
U2 - 10.1016/j.jval.2018.01.021
DO - 10.1016/j.jval.2018.01.021
M3 - Article
VL - 21
SP - 1269
EP - 1277
JO - Value in health
JF - Value in health
SN - 1098-3015
IS - 11
ER -