Patient Preferences for Early Diagnosis of Endometriosis and Associated Determinants in the United States: A Discrete Choice Experiment

Background: Endometriosis is a chronic and incurable gynecological disease that mainly affects women of reproductive age worldwide. It imposes clinical and economic burdens on patients, families, and society. A better understanding of the determinants of preferences towards early diagnosis of endometriosis may help develop programs and interventions to reduce the risk of more severe illness. We quantified patient preferences for early endometriosis diagnosis and explored whether preferences vary on the patient characteristics and pre-established social determinants of health. Methods: A discrete choice experiment (DCE) was designed to elicit women's preferences and willingness to pay for early diagnosis of endometriosis. Women ages 18 and older were eligible to participate in the study. The attributes (and levels) considered to describe hypothetical scenarios included diagnosis (immediate/postponed), the chance of advanced endometriosis and more severe illness (low/ high), time away from living, and professional activities (8 days, 15 days, 22 days and 30 days), and possible out-of pocket costs ($0, $15, $60 and $210). The effects of participants' characteristics and social determinants of health on the preference for early diagnosis were modeled using a Tobit model. Results: A total of 66 women with (2) or at-risk (64) of endometriosis completed the experiment. The respondents' age and insurance statuses significantly influenced their preference or choice for early diagnosis. On average, respondents were willing to give up $61.55 out-of-pocket cost to have a low risk of advanced endometriosis and more severe disease. The Tobit model indicates only age and insurance variables significantly affected early diagnosis preference. The results suggest that older ages and not having insurance increase the likelihood of respondents choosing early diagnosis than the younger age group and having insurance. Conclusions: This study indicates the importance of considering the patient characteristics and social determinants of health when designing and implementing health programs and interventions for endometriosis.