DISCRETE CHOICE EXPERIMENT AS A TOOL TO CHANGE MEDICAL PRACTICE EFFICIENTLY: AN APPLICATION TO BASAL CELL CARCINOMA FOLLOW-UP VISITS

   Purpose: To obtain insights into patients’ preferences to reach optimal basal cell carcinoma (BCC) care, and to ascertain patients will accept fewer follow-up contacts in line with guideline recommendations.

   Method(s): We conducted a multicentre discrete choice experiment (DCE) in six Dutch medical centres. Recently diagnosed BCC patients had to choose between 3 different BCC follow-up scenarios, with variation in the following attributes: ‘type of health care professional’, ‘whether the first post-treatment follow-up was conducted by the same treating health care professional’,  ‘frequency of follow-up visits’, ‘duration of the follow-up visit’, and ‘how much of the skin was inspected’. The costs of the follow-up visits were provided based on real-life scenarios. A latent class model was used to analyse the DCE data.

   Result(s): The questionnaire was completed by 265 BCC patients (71.4% response rate). In general, respondents accepted fewer BCC follow-up visits and were willing to go to their general practitioner (GP) in case questions raised or reassurance was requested (P<0.01) under the condition that 1) the first post-treatment follow-up was conducted by the same health care professional who has treated the patient, and 2) the patient received a customised letter with concrete and personalised information about the BCC, treatment and prognosis. There was significant preference heterogeneity: lower educated men preferred receiving no follow-up after treatment for BCC (P<0.01) and were more willing to follow the guidelines, whereas high educated women with a history of BCC had a preference for frequently scheduled follow-up visits (P<0.05) and preferred follow-up visits with a full skin inspection by the dermatologist over visits to the GP (P<0.01).

   Conclusion(s): BCC patients will accept fewer follow-up visits than in the current situation and are willing to go to their GP for follow-up, if the first post-treatment follow-up visit would be executed by the same health care professional who treated the patient, and if the patient would receive a letter containing concrete and personalised information. The preference heterogeneity shows that particularly high educated women with a BCC history may need more awareness and trust for fewer follow-up visits to be acceptable. Our results indicate that DCEs hold the potential to investigate how to reach optimal care in an efficient way and may help to avoid trial and error implementation to change medical practice.