Value judgments for priority setting criteria in genetic testing: a discrete choice experiment.
As our understanding of genetics has increased, so has the number of genetic tests that have entered clinical practice. Given the need of many European health care systems to contain costs, the question of how to prioritise genetic tests fairly has become an emerging concern. This study uses a discrete-choice experiment to assess the value judgements of clinical geneticists, patient representatives and other stakeholders regarding the prioritisation of genetic tests. The respondents chose between two hypothetical scenarios that differed in severity of the disease, risk of the disease, aim of the test, medical benefit of the test, and costs of the test. Standard logit models and mixed effects models were used to estimate the weights different stakeholders attached to attribute levels. Responses from 594 participants were analysed. The most highly valued attribute levels were a proven medical benefit of the test, high risk of having the disease and low costs of the test. Results also showed that rankings differ between clinical geneticists and other stakeholders. The priority weights determined within this study can inform the policy debate and improve the consistency of prioritisation in genetics. Further stakeholder deliberation is needed to explore their most appropriate use in decision practice.
Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management (IGM), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany. Electronic address: franziska.severin@helmholtz-muenchen.de.
Franziska
F
Severin
Lund University, Department of Economics and Centre for Economic Demography, P.O. Box 7082, S-220 07 Lund, Sweden. Electronic address: wolfgang.hess@nek.lu.se.
Wolfgang
W
Hess
Hannover Medical School, Institute for Human Genetics, Carl-Neuberg-Strasse 1, 30625 Hanover, Germany. Electronic address: Schmidtke.Joerg@mh-hannover.de.
Jörg
J
Schmidtke
Hochschule Neubrandenburg, IGM - Institut Gesundheitsökonomie und Medizinmanagement, Brodaer Straße 2, 17033 Neubrandenburg, Germany. Electronic address: muehlbacher@me.com.
Axel
A
Mühlbacher
Ludwig Maximilians University, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Center, Ziemssenstraße 1, 80336 Munich, Germany; Ludwig Maximilians University, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Center, Ziemssenstraße 1, 80336 Munich, Germany. Electronic address: rogowski@helmholtz-muenchen.de.
Wolf
W
Rogowski
D003362:Cost-Benefit Analysis; D030342:Genetic Diseases, Inborn / Q000175:diagnosis / Q000235:genetics; D005820:Genetic Testing; D006291:Health Policy; D006292:Health Priorities / Q000458:organization & administration; D006801:Humans; D011050:Policy Making; D019057:Quality-Adjusted Life Years; D040841:Resource Allocation / Q000379:methods / Q000458:organization & administration; D018570:Risk Assessment
Discrete choice experiment; Genetic testing; Resource allocation; Stakeholder