Purpose: To determine men’s preferences for prostate cancer (PC) screening, and to elicit the trade-offs they make.
Method: A discrete choice experiment (DCE) was conducted among a population based random sample of 1,000 elderly men (55-75 years old). A panel latent class model was used to determine men’s preferences for PC screening. Trade-offs were quantified between five PC screening programme aspects: risk reduction of PC related death, screening interval, risk of unnecessary biopsies, risk of unnecessary treatments, and out-of-pocket costs.
Result: The response rate was 46% (459/1,000). Respondents and non-respondents did not differ in age (p=0.44) or marital status (p=0.62). All five PC screening aspects significantly influenced men’s preferences, but preference heterogeneity was substantial. Men with higher educational levels had a lower probability to opt for PC screening than men with lower educational levels. In general, men were willing to trade-off 4.2% (CI: -6.8% to 18.6%) or 3.2% (CI: -6.1% to 15.3%) risk reduction of PC related death to decrease their risk of unnecessary treatment or unnecessary biopsy with 10%, respectively. They were willing to pay €214 per year (CI: -€372 to €932) to reduce their relative risk of PC related death with 10%, or €80 per year (CI: -€158 to €379) to get PC screening every 2 years instead of every 4 years.
Conclusion: Men were willing to trade off some risk reduction of PC related death to be relieved of the burden of biopsies or unnecessary treatments. Men with lower educational levels had a higher probability to prefer PC screening than men with higher educational levels. Increasing knowledge on over-diagnosis and overtreatment, especially for men with lower educational levels, is warranted to prevent unrealistic expectations from PC screening and to optimise informed choice.
See more of: The 34th Annual Meeting of the Society for Medical Decision Making