Sean A Woolen1, Amit G Singal2, Matthew S Davenport3, Jonathan P Troost4, Shokoufeh Khalatbari4, Sukul Mittal5, Sehar Siddiqui6, Austin Fobar6, Jason Morris7, Mobolaji Odewole5, Elliot B Tapper6, Anjana Pillai8, Neehar D Parikh9. 1. Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California. 2. Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas; North American Liver Cancer Consortium. 3. Department of Radiology, Michigan Medicine, Ann Arbor, Michigan; Department of Urology, Michigan Medicine, Ann Arbor, Michigan. 4. Michigan Institute for Clinical and Health Research, Michigan Medicine, Ann Arbor, Michigan. 5. Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas. 6. Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan. 7. Center for Liver Disease, University of Chicago, Chicago, Illinois. 8. North American Liver Cancer Consortium; Center for Liver Disease, University of Chicago, Chicago, Illinois. 9. North American Liver Cancer Consortium; Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan. Electronic address: ndparikh@med.umich.edu.
Abstract
BACKGROUND AND AIMS: Professional societies recommend abdominal ultrasound (US) with or without alpha fetoprotein (AFP) for hepatocellular cancer (HCC) surveillance; however, there are several emerging surveillance modalities, including abbreviated MRI and blood-based biomarker panels. Most studies have focused on provider perspectives for surveillance logistics, but few have assessed patient preferences. We aimed to measure preferences among patients with cirrhosis regarding HCC surveillance modalities. METHODS: We conducted a choice-based conjoint survey to patients with cirrhosis at four institutions. Participants were provided 15 scenarios in which they were asked to choose surveillance modalities based on five test attributes: benefits, i.e. sensitivity for early HCC (range: 35-95%), physical harm, i.e. false positives requiring additional testing (range: 10-40%), financial harm, i.e. out-of-pocket costs (range: $10-100), test logistics and convenience, i.e. duration of testing (range: 10-60 min). Hierarchical Bayes discrete choice conjoint analysis was used to derive attribute importance, and preference shares were determined by simulation. RESULTS: In total 91% (182/199) of approached patients consented to participate in the study and 98% (n=179) successfully completed the survey. Surveillance benefits (importance: 51.3%, 95%CI: 49.0-53.4%) were valued more than risk of physical harm (importance: 7.6%, 95%CI 7.0-8.2%), financial harm (importance: 15.2%, 95%CI 14.0-16.3%), convenience (importance: 9.3%, 95%CI 8.5-10.1%) and test logistics (importance: 16.7%, 95%CI 15.4-18.1%). Based on simulations including all possible tests, patients preferred abbreviated MRI (29.0%), MRI (23.3%), or novel blood-based biomarkers (20.9%) to ultrasound alone (3.4%) or with AFP (8.8%). CONCLUSIONS: Patients with cirrhosis prioritize early HCC detection over potential surveillance-related harms or inconvenience.
BACKGROUND AND AIMS: Professional societies recommend abdominal ultrasound (US) with or without alpha fetoprotein (AFP) for hepatocellular cancer (HCC) surveillance; however, there are several emerging surveillance modalities, including abbreviated MRI and blood-based biomarker panels. Most studies have focused on provider perspectives for surveillance logistics, but few have assessed patient preferences. We aimed to measure preferences among patients with cirrhosis regarding HCC surveillance modalities. METHODS: We conducted a choice-based conjoint survey to patients with cirrhosis at four institutions. Participants were provided 15 scenarios in which they were asked to choose surveillance modalities based on five test attributes: benefits, i.e. sensitivity for early HCC (range: 35-95%), physical harm, i.e. false positives requiring additional testing (range: 10-40%), financial harm, i.e. out-of-pocket costs (range: $10-100), test logistics and convenience, i.e. duration of testing (range: 10-60 min). Hierarchical Bayes discrete choice conjoint analysis was used to derive attribute importance, and preference shares were determined by simulation. RESULTS: In total 91% (182/199) of approached patients consented to participate in the study and 98% (n=179) successfully completed the survey. Surveillance benefits (importance: 51.3%, 95%CI: 49.0-53.4%) were valued more than risk of physical harm (importance: 7.6%, 95%CI 7.0-8.2%), financial harm (importance: 15.2%, 95%CI 14.0-16.3%), convenience (importance: 9.3%, 95%CI 8.5-10.1%) and test logistics (importance: 16.7%, 95%CI 15.4-18.1%). Based on simulations including all possible tests, patients preferred abbreviated MRI (29.0%), MRI (23.3%), or novel blood-based biomarkers (20.9%) to ultrasound alone (3.4%) or with AFP (8.8%). CONCLUSIONS: Patients with cirrhosis prioritize early HCC detection over potential surveillance-related harms or inconvenience.
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