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

Xin Yi Wong, Catharina G. M. Groothuis-Oudshoorn, Chuen Seng Tan, Janine A. van Til, Mikael Hartman, Kok Joon Chong, Maarten J. IJzerman, Hwee-Lin Wee

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Abstract

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.

Original languageEnglish
Pages (from-to)1837-1852
Number of pages16
JournalPatient Preference and Adherence
Volume12
DOIs
Publication statusPublished - Sep 2018

Keywords

  • single-nucleotide polymorphisms
  • gene testing
  • personalized breast cancer screening
  • precision medicine
  • women's preferences
  • willingness-to-pay
  • predicted uptake
  • discrete choice experiment

Cite this

@article{425ba46057744b03b0e71efc6ab33cf6,
title = "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",
abstract = "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",
author = "Wong, {Xin Yi} and Groothuis-Oudshoorn, {Catharina G. M.} and Tan, {Chuen Seng} and {van Til}, {Janine A.} and Mikael Hartman and Chong, {Kok Joon} and IJzerman, {Maarten J.} and Hwee-Lin Wee",
year = "2018",
month = "9",
doi = "10.2147/PPA.S171348",
language = "English",
volume = "12",
pages = "1837--1852",
journal = "Patient Preference and Adherence",
issn = "1177-889X",
publisher = "Dove Medical Press Ltd.",

}

TY - JOUR

T1 - Women's preferences, willingness-to-pay, and predicted uptake for single-nucleotide polymorphism gene testing to guide personalized breast cancer screening strategies

T2 - a discrete choice experiment

AU - Wong, Xin Yi

AU - Groothuis-Oudshoorn, Catharina G. M.

AU - Tan, Chuen Seng

AU - van Til, Janine A.

AU - Hartman, Mikael

AU - Chong, Kok Joon

AU - IJzerman, Maarten J.

AU - Wee, Hwee-Lin

PY - 2018/9

Y1 - 2018/9

N2 - 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.

AB - 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.

KW - single-nucleotide polymorphisms

KW - gene testing

KW - personalized breast cancer screening

KW - precision medicine

KW - women's preferences

KW - willingness-to-pay

KW - predicted uptake

KW - discrete choice experiment

U2 - 10.2147/PPA.S171348

DO - 10.2147/PPA.S171348

M3 - Article

VL - 12

SP - 1837

EP - 1852

JO - Patient Preference and Adherence

JF - Patient Preference and Adherence

SN - 1177-889X

ER -