Individual preferences on the balancing of good and harm of cardiovascular disease screening

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Tina Birgitte Hansen, Zealand University Hospital, University of Southern Denmark, Odense, Danmark
  • Jes Sanddal Lindholt
  • Axel Cosmus Pyndt Diederichsen, Department of Cardiology, Odense University Hospital, Odense, Denmark., Elitary Research Unit of Personalized Medicine in Arterial Disease (CIMA), Odense University Hospital, Danmark
  • Michiel C J Bliemer, Institute of Transport and Logistics Studies, University of Sydney Business School, Sydney, New South Wales, Australia., Australien
  • Jess Lambrechtsen, Department of Cardiology, Odense University Hospital, Odense, Denmark.
  • ,
  • Flemming Hald Steffensen, Department of Cardiology, Lillebaelt Hospital Vejle, Denmark.
  • ,
  • Rikke Søgaard

OBJECTIVE: Transition towards value-based healthcare requires insight into what makes value to the individual. The aim was to elicit individual preferences for cardiovascular disease screening with respect to the difficult balancing of good and harm as well as mode of delivery.

METHODS: A discrete choice experiment was conducted as a cross-sectional survey among 1231 male screening participants at three Danish hospitals between June and December 2017. Participants chose between hypothetical screening programmes characterised by varying levels of mortality risk reduction, avoidance of overtreatment, avoidance of regretting participation, screening duration and location. A multinomial mixed logit model was used to model the preferences and the willingness to trade mortality risk reduction for improvements on other characteristics.

RESULTS: Respondents expressed preferences for improvements on all programme characteristics. They were willing to give up 0.09 (95% CI 0.08 to 0.09) lives saved per 1000 screened to avoid one individual being over treated. Similarly, respondents were willing to give up 1.22 (95% CI 0.90 to 1.55) or 5.21 (95% CI 4.78 to 5.67) lives saved per 1000 screened to upgrade the location from general practice to a hospital or to a high-tech hospital, respectively. Subgroup analysis revealed important preference heterogeneity with respect to smoking status, level of health literacy and self-perceived risk of cardiovascular disease.

CONCLUSIONS: Individuals are able to express clear preferences about what makes value to them. Not only health benefit but also time with health professionals and access to specialised facilities were important. This information could guide the optimal programme design in search of value-based healthcare.

Sider (fra-til)761-767
Antal sider7
StatusUdgivet - maj 2019

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