title: Cost sharing and hereditary cancer risk: predictors of willingness-to-pay for genetic testing.
abstract: Increasing use of predictive genetic testing to gauge hereditary cancer risk has been paralleled by rising cost-sharing practices. Little is known about how demographic and psychosocial factors may influence individuals' willingness-to-pay for genetic testing. The Gastrointestinal Tumor Risk Assessment Program Registry includes individuals presenting for genetic risk assessment based on personal/family cancer history. Participants complete a baseline survey assessing cancer history and psychosocial items. Willingness-to-pay items include intention for: genetic testing only if paid by insurance; testing with self-pay; and amount willing-to-pay ($25-$2,000). Multivariable models examined predictors of willingness-to-pay out-of-pocket (versus only if paid by insurance) and willingness-to-pay a smaller versus larger sum (≤$200 vs. ≥$500). All statistical tests are two-sided (α = 0.05). Of 385 evaluable participants, a minority (42%) had a personal cancer history, while 56% had ≥1 first-degree relative with colorectal cancer. Overall, 21.3% were willing to have testing only if paid by insurance, and 78.7% were willing-to-pay. Predictors of willingness-to-pay were: 1) concern for positive result; 2) confidence to control cancer risk; 3) fewer perceived barriers to colorectal cancer screening; 4) benefit of testing to guide screening (all p < 0.05). Subjects willing-to-pay a higher amount were male, more educated, had greater cancer worry, fewer relatives with colorectal cancer, and more positive attitudes toward genetic testing (all p < 0.05). Individuals seeking risk assessment are willing-to-pay out-of-pocket for genetic testing, and anticipate benefits to reducing cancer risk. Identifying factors associated with willingness-to-pay for genetic services is increasingly important as testing is integrated into routine cancer care.
authors.affiliation: Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA, jennifer.matro@fccc.edu.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Matro
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Ruth
authors.forename: Yu-Ning
authors.initials: YN
authors.lastname: Wong
authors.forename: Katen C
authors.initials: KC
authors.lastname: McCully
authors.forename: Christina M
authors.initials: CM
authors.lastname: Rybak
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Meropol
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hall
mesh_terms: D001294:Attitude to Health; D017047:Cost Sharing / Q000191:economics*; D005163:Factor Analysis, Statistical; D005260:Female; D005820:Genetic Testing / Q000191:economics*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000191:economics* / Q000235:genetics* / Q000517:prevention & control; D018570:Risk Assessment; D014481:United States