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Perceived importance of the benefits and harms of colorectal cancer screening: a best-worst scaling study

Published:January 13, 2023DOI:https://doi.org/10.1016/j.jval.2022.12.015
Perceived importance of the benefits and harms of colorectal cancer screening: a best-worst scaling study
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      Highlights

      • •
        Colorectal cancer screening is beneficial on a population level, but the benefits do not always outweigh the potential harms on an individual level. Individual preferences play an important role in weighing the benefits and harms of participating in screening.
      • •
        In this study, we quantified how important screening invitees perceived the harms of colorectal cancer screening as compared to the benefits.
      • •
        The preference values obtained in this study will be used to help screening invitees make an informed decision about participating in screening.

      Abstract

      Objective

      To elicit the relative importance of the benefits and harms of colorectal cancer (CRC) screening among potential screening participants in the Dutch population.

      Methods

      In a consensus meeting with 11 experts, risk reduction of CRC and CRC deaths (benefits) and complications from colonoscopy, stress of receiving positive fecal immunological test (FIT) results, as well as false positive and false negative FIT results (harms) were selected as determinant end points to consider during decision making. We conducted an online best-worst scaling survey among adults aged 55 to 75 years from the Nivel Dutch Health Care Consumer Panel to elicit preference values for these outcomes. The preference values were estimated using conditional logit regression.

      Results

      Of 265 participants, 234 (89%) had ever participated in CRC screening. Compared to stress of receiving a positive FIT result, the outcome perceived most important was the risk of CRC death (OR 4.5, 95% CI 3.9 to 5.1), followed by risk of CRC (OR 4.1, 95% CI 3.6 to 4.7), a false negative FIT result (OR 3.1, 95% CI 2.7 to 3.5), colonoscopy complications (OR 1.6, 95% CI 1.4 to 1.8), and a false positive FIT result (OR 1.4, 95% CI 1.3 to 1.6). The magnitude of these differences in perceived importance varied according to age, educational level, ethnic background and whether the individual had previously participated in CRC screening.

      Conclusion

      Dutch men and women eligible for FIT-based CRC screening perceive the benefits of screening to be more important than the harms.

      Keywords

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      Article info

      Publication history

      Accepted: December 30, 2022
      Received in revised form: December 16, 2022
      Received: May 25, 2022

      Publication stage

      In Press Accepted Manuscript

      Footnotes

      Precis: Men and women invited for colorectal cancer screening perceive the benefits of screening more important than the harms.

      Author contributions:

      Concept and design: Pluymen, Yebyo, Stegeman, Fransen, Dekker, Brabers, Leeflang

      Acquisition of data: Pluymen, Brabers

      Analysis and interpretation of data: Pluymen, Yebyo, Brabers

      Drafting of the manuscript: Yebyo

      Critical revision of the paper for important intellectual content: Pluymen, Yebyo, Stegeman, Fransen, Dekker, Brabers, Leeflang

      Statistical analysis: Yebyo, Brabers

      Provision of study materials or patients: Pluymen, Brabers

      Obtaining funding: Stegeman, Fransen, Dekker, Leeflang

      Administrative, technical, or logistic support: Pluymen, Brabers

      Supervision: Leeflang

      Conflict of interest disclosure Statement:

      Dr Leeflang reported receiving grants from ZonMw, during the conduct of the study. Dr Dekker reported receiving grants, personal fees, and non-financial support from FujiFilm, personal fees from Olympus, GI Supply, Norgine, IPSEN, PAION, and Ambu, outside the submitted work. No other disclosures were reported.

      Funding/support: This study was funded by ZonMw, the Dutch organization for health research and healthcare innovation.

      Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

      Acknowledgements: We thank Francine van Wifferen, MSc, dr. Marjolein Greuter, and prof. dr. Veerle Coupé of the Amsterdam UMC decision modeling center for their statistical support.

      Identification

      DOI: https://doi.org/10.1016/j.jval.2022.12.015

      Copyright

      © 2023 International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc.

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