Provider preferences for resolving uncertainty and avoiding harms in precision medicine: a discrete choice experiment

Per Med. 2020 Sep;17(5):389-398. doi: 10.2217/pme-2020-0018. Epub 2020 Aug 17.

Abstract

Background: Substantial uncertainty exists about how providers assess the value of genomic testing. Materials & methods: We developed and administered a discrete choice experiment to a national sample of providers. We analyzed responses using an error components mixed logit model. Results: We received responses from 356 providers. The attributes important to providers were patient health and function, life expectancy, cost, expert agreement, and biomarker prevalence. Providers significantly valued reducing uncertainty only when it eliminated the possibility of decreased life expectancy. Providers valued improving certainty about life expectancy gains from 12 ± 18 to 12 ± 6 months at US$400 (US$200-600) versus US$200 (-US$60-500) for 4 ± 4 to 4 ± 2 years. Conclusion: Providers value resolving uncertainty most when it eliminates the possibility of substantial harm.

Keywords: behavioral economics; conjoint analysis; discrete choice experiment; genomic testing; personalized medicine; pharmacogenomics; precision medicine; preference assessment; uncertainty.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Clinical Decision-Making / methods*
  • Decision Support Techniques
  • Genetic Testing / economics
  • Humans
  • Life Expectancy
  • Practice Patterns, Physicians'
  • Precision Medicine / economics
  • Precision Medicine / methods*
  • Surveys and Questionnaires
  • Uncertainty