Eliciting Patient Preferences for Hepatocellular Carcinoma Screening: A Choice-Based Conjoint Analysis

Soudabeh Fazeli; Yesenia Covarrubias; Shirin Bassirian; Jordan Cuevas; Kathryn Fowler; Irine Vodkin; Yuko Kono; Robert Marks; Rohit Loomba; Bachir Taouli; Claude Sirlin; Ruth Carlos

doi:10.1016/j.jacr.2022.01.015

Eliciting Patient Preferences for Hepatocellular Carcinoma Screening: A Choice-Based Conjoint Analysis

J Am Coll Radiol. 2022 Apr;19(4):502-512. doi: 10.1016/j.jacr.2022.01.015. Epub 2022 Mar 3.

Authors

Soudabeh Fazeli¹, Yesenia Covarrubias², Shirin Bassirian³, Jordan Cuevas⁴, Kathryn Fowler⁵, Irine Vodkin⁶, Yuko Kono⁷, Robert Marks⁸, Rohit Loomba⁹, Bachir Taouli¹⁰, Claude Sirlin¹¹, Ruth Carlos¹²

Affiliations

¹ Neuroradiology Fellow, Department of Radiology, University of California San Diego, San Diego, California. Electronic address: soodabeh.fazeli@gmail.com.
² Clinical Research Analyst, Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California.
³ Clinical Researcher, Division of Gastroenterology & Hepatology, Department of Medicine, University of California San Diego, San Diego, California.
⁴ Clinical Research Manager Department of Diagnostic, Molecular and Interventional Radiology and BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
⁵ Member of ACR LI-RADS Steering Committee and Working Group; and Associate Professor of Radiology, Director of Abdominal and Pelvic Magnetic Resonance Imaging and Director of the Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California.
⁶ Assistant Professor of Medicine, Division of Gastroenterology & Hepatology, Department of Medicine, University of California San Diego, San Diego, California.
⁷ Chair of ACR CEUS LI-RADS; and Professor of Medicine and Radiology, Division of Gastroenterology & Hepatology, Department of Medicine, University of California San Diego, San Diego, California.
⁸ Member of ACR LI-RADS Steering Committee; Chief of Body Imaging, Department of Radiology, Naval Medical Center San Diego, San Diego, California; and Associate Professor of Radiology, Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
⁹ Professor of Medicine in the Division of Gastroenterology and Adjunct Professor in the Division of Epidemiology, University of California University of California San Diego, San Diego, California.
¹⁰ Professor of Radiology and Medicine, Director of Body MRI and Cancer Imaging, Department of Diagnostic, Molecular and Interventional Radiology and BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
¹¹ Chair of ACR LI-RADS Steering Committee and Working Group; and Professor of Radiology, Founder and Director of the Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California.
¹² Editor-in-Chief of the JACR; and Department of Radiology, Michigan Medicine, Ann Arbor, Michigan.

PMID: 35248523
DOI: 10.1016/j.jacr.2022.01.015

Abstract

Background: Abbreviated MRI (AMRI), proposed as an alternative imaging modality for hepatocellular carcinoma screening, provides higher sensitivity than ultrasound. It is, however, unknown how patients weigh the higher sensitivity of AMRI against its higher cost and potentially less desirable testing experience.

Purpose: To assess patient preferences for hepatocellular carcinoma screening test attributes including sensitivity, false-positive rate, test-related anxiety, cost, and need for intravenous catheterization and contrast use, measured by choice-based conjoint analysis.

Materials and methods: This was an ancillary study to two prospective dual-center studies designed to compare the hepatocellular carcinoma detection rates by ultrasound versus AMRI. Of the 135 eligible participants, 106 (median age 63, range 25-85; 56% male) completed the choice-based conjoint analysis survey and were included in this substudy. Participants' preference for individual screening test attributes was assessed using a 12-item, web-based choice-based conjoint analysis survey administered in person at the screening visit. Conjoint analyses software and hierarchical Bayes random-effects logit model were used to calculate the relative importance of each attribute.

Results: The most important attribute driving patient preferences was higher test sensitivity (importance score 39.8%), followed by lower cost (importance score 22.8%) and lower false-positive rate (importance score 19.4%). The overall estimated participants' preference for ultrasound and AMRI were similar when assuming the same specificity for both modalities.

Conclusion: Higher screening test sensitivity and lower cost were the leading patient preference drivers. This study has important implications for understanding patient preferences for specific screening test characteristics as potential determinants of adherence.

Keywords: Abbreviated MRI; choice-based conjoint analyses; hepatocellular carcinoma screening; patient preference; ultrasound.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Bayes Theorem
Carcinoma, Hepatocellular* / diagnostic imaging
Female
Humans
Liver Neoplasms* / diagnostic imaging
Male
Middle Aged
Patient Preference
Prospective Studies
Surveys and Questionnaires

Grants and funding

T32 EB005970/EB/NIBIB NIH HHS/United States