Public Preference Heterogeneity and Predicted Uptake for Upper Gastrointestinal Cancer Screening: A Latent Class Analysis (Preprint)

BACKGROUND The low uptake rate of upper gastrointestinal cancer (UGC) screening remains a major public health challenge worldwide. OBJECTIVE The objective of this study was to determine what characteristics influence the residents’ preference heterogeneity for a UGC screening program and to assess to what extent these characteristics predict residents’ participation rates. METHODS A discrete choice experiment (DCE) was conducted in 1000 subjects aged 40-69 years who were randomly selected from three countries of Shandong province in China. Each respondent was repeatedly asked to make a choice from 9 screening scenarios comprised with screening interval, screening technique, regular follow-up for precancerous lesions, mortality reduction, and out-of-pocket costs. The latent class logit model (LCL) was used to estimate residents’ preference heterogeneity when selecting the UGC screening programs. RESULTS The best model contained four latent classes of respondents, defined by different preferences for the five attributes. In the four-class model, 88 (9.50%) residents were assigned to class 1, 216 (23.33%) residents to class 2, 434 (46.89%) residents to class 3, 188 (20.30%n) residents to class 4. All residents in different classes have different preferences for the five selected attributes, except for painless endoscopy. Their participation rate could increase 89% and above (except for the 60.98% in class 2) if the optimal UGC screening option with free, follow up, 45% mortality reduction, every year, and painless endoscopy was implemented. CONCLUSIONS Public preference heterogeneity for UGC screening does exists, and this heterogeneity was explored and analyzed in this study. Most residents have a positive attitude toward UGC screening, but their preferences vary in selected attributes including screening interval, screening technique, regular follow-up for precancerous lesions, mortality reduction, and out-of-pocket costs. Policy makers should take these heterogeneities into account to formulate UGC screening programs with high uptake.