Individual Preference for Fecal Immunochemical Test Options among Younger Adults: A Discrete Choice Experiment.

Abstract

Objectives: This study aims to quantify the preference of adults below 50 years of age for fecal immunochemical test (FIT) options as screening for colorectal cancer (CRC) and its disparities across different subgroups.

Methods: A discrete choice experiment (DCE) was conducted among adults aged < 50 years old in Hong Kong. A mixed logit model and latent class model were used to estimate their preference, taking into account their preference heterogeneity. Marginal willingness-to-pay for changes in the attribute levels was also estimated.

Results: A total of 408 participants with valid responses were included for analysis. The outcomes showed 5.2% of participants would consistently reject all the 20 FIT alternatives presented to them in the DCE survey. Mortality reduction in FIT programs was deemed as the most important attribute, followed by testing frequency, early detection likelihood, familiar physician, and reduction of false positive rate. The FIT acceptance was sensitive to the change of out-of-pocket payment amount. The latent class model showed participants with different ages, educational level, and self-reported health status would have different preferences for FIT attribute levels.

Conclusions: The study showed that most adults below 50 years old would be willing to consider receiving FIT if suitable testing options are available. They are more sensitive to changes in mortality reduction than changes in CRC early detection likelihood, suggesting the former is more important in information dissemination. The impact of out-of-pocket payments for FIT on its acceptance suggests that the introduction of financial subsidies can be considered to improve screening acceptance. The preference heterogeneity highlights the importance of healthcare professionals' understanding of people's values and preferences for decision-making.