title: Patient preference and willingness to pay for transient elastography versus liver biopsy: A perspective from British Columbia.
abstract: BACKGROUND
  The cost of liver biopsy (LB) is publicly funded in British Columbia, while the cost of transient elastography (FibroScan [FS], Echosens, France) is not. Consequently, there is regional variation regarding FS access and monitoring of liver disease progression.
  
  
  OBJECTIVE
  To evaluate patient preference for FS versus LB and to assess the willingness to self-pay for FS.
  
  
  METHODS
  Questionnaires were distributed in clinic and via mail to LB-experienced and LB-naive patients who underwent FS at Vancouver General Hospital, Vancouver, British Columbia.
  
  
  RESULTS
  The overall response rate was 76%. Of the 422 respondents, 205 were LB-experienced. The mean age was 53.5 years, 50.2% were male, 54.7% were Caucasian, 38.2% had hepatitis C and 26.3% had an annual household income >$75,000. Overall, 95.4% of patients preferred FS to LB. FS was associated with greater comfort than LB, with the majority reporting no discomfort during FS (84.1% versus 7.8% for LB), no discomfort after (96.2% versus 14.6% LB) and no feelings of anxiety after FS explanation (78.2% versus 12.7% LB). FS was also associated with greater speed, with the majority reporting short test duration (97.2% versus 48.3% LB) and short wait for the test result (95.5% versus 30.2% LB). Most (75.3%) respondents were willing to self-pay for FS, with 26.3% willing to pay $25 to $49. Patients with unknown liver disease preferred LB (OR [FS preference] 0.20 [95% CI 0.07 to 0.53]).
  
  
  CONCLUSIONS
  FS was the preferred method of assessing liver fibrosis among patients, with the majority willing to self-pay. To ensure consistency in access, provincial funding for FS is needed. However, LB remains the procedure of choice for individuals with an unknown diagnosis.
authors: Victoria Yui-Min
authors: VY
authors: Kan
authors: Vladimir
authors: V
authors: Marquez Azalgara
authors: Jo-Ann E
authors: JA
authors: Ford
authors: W C
authors: WC
authors: Peter Kwan
authors: Siegfried Roland
authors: SR
authors: Erb
authors: Eric M
authors: EM
authors: Yoshida
mesh_terms: D000328:Adult; D001706:Biopsy / Q000191:economics / Q000523:psychology*; D001955:British Columbia; D054459:Elasticity Imaging Techniques / Q000191:economics / Q000523:psychology*; D005249:Fees and Charges; D005260:Female; D005382:Financing, Personal; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000191:economics / Q000523:psychology*; D011795:Surveys and Questionnaires