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Preferences for Surveillance of Barrett’s Oesophagus: a Discrete Choice Experiment

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Purpose

Endoscopic surveillance for Barrett’s oesophagus is undertaken to detect dysplasia and early cancer, and to facilitate early intervention. Evidence supporting current practice is of low quality and often influenced by opinion. This study investigated the preferences of patients for surveillance of Barrett’s oesophagus in an Australian cohort.

Methods

Four Barrett’s oesophagus surveillance characteristics/attributes were evaluated within a discrete choice experiment based on literature and expert opinion: (1) surveillance method (endoscopy vs a blood test vs a novel breath test), (2) risk of missing a cancer over a 10-year period, (3) screening interval, and (4) out-of-pocket cost. The data from the discrete choice experiment was analysed within the framework of random utility theory using a mixed logit regression model.

Results

The study sample comprised patients (n = 71) undergoing endoscopic surveillance for Barrett’s oesophagus of whom n = 65 completed the discrete choice experiment. The sample was predominantly male (77%) with average age of 65 years. All attributes except surveillance method significantly influenced respondents’ preference for Barrett’s oesophagus surveillance. Policy analyses suggested that compared to the reference case (i.e. endoscopy provided annually at no upfront cost and with a 4% risk of missing cancer), increasing test sensitivity to 0.5% risk of missing cancer would increase participation by up to 50%; surveillance every 5 years would lead to 26% reduction, while every 3 to 3.5 years would result in 7% increase in participation. Respondents were highly averse to paying A$500 for the test, resulting in 48% reduction in participation. None of the other surveillance methods was preferred to endoscopy, both resulting in 11% reduction in participation.

Conclusion

Test sensitivity, test frequency and out-of-pocket cost were the key factors influencing surveillance uptake. Patients prefer a test with the highest sensitivity, offered frequently, that incurs no upfront costs.

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Acknowledgements

We thank Ms. Ann Schloithe and Mr. Jeff Bull for their support with accessing the clinical databases to identify participants and for mailing out the questionnaires.

Funding

Professor Watson, Professor Ratcliffe and Professor Fraser received a Beat Cancer Hospital Research Package Grant which was funded by the Cancer Council of South Australia’s Beat Cancer Project on behalf of its donors and the State Government of South Australia Department of Health, together with the support of the Flinders Medical Centre Foundation, its donors and partners. This Grant funded Dr. Norma Bulamu’s and Dr. Gang Chen’s salary.

Author information

Authors and Affiliations

  1. Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, SA, 5041, Australia

    Norma B. Bulamu, Gang Chen & David I. Watson

  2. Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

    Tim Bright & David I. Watson

  3. Institute of Choice, University of South Australia Business School, Adelaide, SA, Australia

    Julie Ratcliffe

  4. Discipline of Gastroenterology and Hepatology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

    Adrian Chung & Robert J. L. Fraser

  5. Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden

    Björn Törnqvist

Authors
  1. Norma B. Bulamu
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  2. Gang Chen
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  3. Tim Bright
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  4. Julie Ratcliffe
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  5. Adrian Chung
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  6. Robert J. L. Fraser
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  7. Björn Törnqvist
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  8. David I. Watson
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Contributions

N B B: substantially contributed to the acquisition of data, the analysis of the data, the interpretation of data for the work, drafting the manuscript, approved the version that is submitted for peer-review, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

G C: substantially contributed to the conception and design of the study, the acquisition of data, the analysis of the data, the interpretation of data for the work, drafting the manuscript, approved the version that is submitted for peer-review, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

T B: substantially contributed to the conception and design of the study, the acquisition of data, the interpretation of data for the work, critically revised the manuscript for important intellectual content, approved the version that is submitted for peer-review, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

J R: substantially contributed to the conception and design of the study, the interpretation of data for the work, critically revised the manuscript for important intellectual content, approved the version that is submitted for peer-review, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

A C: substantially contributed to the conception and design of the study, the acquisition of data, the interpretation of data for the work, critically revised the manuscript for important intellectual content, approved the version that is submitted for peer-review, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

R J L F: substantially contributed to the conception and design of the study, the acquisition of data, the interpretation of data for the work, critically revised the manuscript for important intellectual content, approved the version that is submitted for peer-review, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

B T: substantially contributed to the conception and design of the study, and critically revised the manuscript for important intellectual content, approved the version that is submitted for peer-review, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

D I W: substantially contributed to the conception and design of the study, the acquisition of data, the interpretation of data for the work, critically revised the manuscript for important intellectual content, approved the version that is submitted for peer-review, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Gang Chen.

Ethics declarations

Informed consent was obtained from all study participants. Ethical approval was obtained from the Southern Adelaide Clinical Human Research Ethics Committee (Reference No. 451.15 - HREC/15/SAC/437).

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Bulamu, N.B., Chen, G., Bright, T. et al. Preferences for Surveillance of Barrett’s Oesophagus: a Discrete Choice Experiment. J Gastrointest Surg 23, 1309–1317 (2019). https://doi.org/10.1007/s11605-018-4049-6

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  • DOI: https://doi.org/10.1007/s11605-018-4049-6

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