Preliminary analysis of preferences and willingness to pay for central venous access in patients with breast cancer_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Shimeng ^1,2 , XIA Zhiyuan ^1,2 , FU Peifen ³ , ZHAO Pei ⁴ , LI Yinfeng ⁵ , CHEN Na ⁶ , WEI Yanan ⁴ , DU Chengyong ³ , MU Wenxuan ⁶ ,  CHEN Yingyao ^1,2

1. School of Public Health, Fudan University, Shanghai 200032, P. R. China;
2. NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai 200032, P. R. China;
3. Department of Breast Surgery, the First Affiliated Hospital, Zhejiang University, Hangzhou 310000, P. R. China;
4. Department of Breast Surgery, Henan Provincial People’s Hospital, Zhengzhou 450003, P. R. China;
5. Department of Nursing, Sichuan Cancer Hospital, Chengdu 610042, P. R. China;
6. Chengdu Medical College, Chengdu 610500, P. R. China;

Corresponding author：

CHEN Yingyao, Email: yychen@shmu.edu.cn

Keywords：

Breast cancer; Patient preferences; Willingness to pay; Central venous access; Discrete choice experiment

DOI：

10.7507/1672-2531.202201024

Video：

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Objective This study aimed to quantitatively investigate the preferences and willingness of patients with breast cancer to pay for central venous access and to provide implications for the clinical selection of appropriate chemotherapy pathways. Methods A discrete-choice experiment survey was conducted to elicit the preferences for central venous access in three hospitals in east, middle and west China. The conditional logit model was used to analyse the relative importance of six central venous access-related attributes: risk of thrombosis, risk of infections, restriction of daily activities, maintenance interval, catheter incision size and out-of-pocket costs. Results The valid data for a total of 103 patients was collected from three hospitals. All six attributes significantly influenced patients’ preferences for central venous access. The risk of thrombosis (RIS=26.0%) and risk of infections (RIS=24.3%) were the top two attributes influencing patients’ preferences for central venous access. To reduce the risk of thrombosis and infection from 12% and 8% to 1%, patients were willing to pay 14 861.2 yuan and 13 907.2 yuan, respectively. The catheter incision size was of least concern (RIS=4.6%); the patients were only willing to pay 2 653.6 yuan for smaller catheter incisions. Conclusion Thrombosis and infection are the primary factors that affect the choice of central venous access for patients with breast cancer. Patients have a sensitive trade-off between safety and out-of-pocket costs; with the change in thrombosis and infection risk, patients’ willingness to pay changes accordingly.

Citation： LIU Shimeng, XIA Zhiyuan, FU Peifen, ZHAO Pei, LI Yinfeng, CHEN Na, WEI Yanan, DU Chengyong, MU Wenxuan, CHEN Yingyao. Preliminary analysis of preferences and willingness to pay for central venous access in patients with breast cancer. Chinese Journal of Evidence-Based Medicine, 2022, 22(4): 380-386. doi: 10.7507/1672-2531.202201024 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	李宜臻, 郑怡, 邓玉皎, 等. 1990~2019年中国女性乳腺癌疾病负担及危险因素研究. 中国循证医学杂志, 2021, 21(8): 876-881.
3.	中心静脉血管通路装置安全管理专家组. 中心静脉血管通路装置安全管理专家共识(2019版). 中华外科杂志, 2020, 58(4): 261-272.
4.	王凯蓉, 周英凤. PICC与CVC, VPA经济学评价研究的系统评价. 护理学杂志, 2019, 34(8): 54-58.
5.	徐凤银, 李惠芬, 李松琴, 等. 三种不同类型中心静脉导管感染临床特点分析. 齐鲁护理杂志, 2019, 25(13): 31-34.
6.	徐文洁, 闻曲, 成芳, 等. 植入式静脉输液港与PICC临床应用现状比较. 中国护理管理, 2013, 13(12): 102-103.
7.	Clark MD, Determann D, Petrou S, et al. Discrete choice experiments in health economics: a review of the literature. Pharmacoeconomics, 2014, 32(9): 883-902.
8.	de Bekker-Grob EW, Ryan M, Gerard K. Discrete choice experiments in health economics: a review of the literature. Health Econ, 2012, 21(2): 145-172.
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10.	Thurstone LL. A law of comparative judgment. Psychol Rev, 1994, 101(2): 266-270.
11.	McFadden D. Conditional logit analysis of qualitative choice behavior. New York: Academic Press, 1974.
12.	胡婉侠, 徐文华, 徐建光, 等. 我国卫生领域离散选择实验应用研究的文献计量分析. 南京医科大学学报(社会科学版), 2020, 20(2): 157-161.
13.	刘世蒙, 夏志远, 魏艳, 等. 离散选择实验在中心静脉输液装置选择偏好中的需求及应用分析. 中国药物经济学, 2021, 16(1): 5-9.
14.	陈莉, 罗凤, 蔡明. 植入式静脉输液港并发症及处理的研究进展. 中华乳腺病杂志(电子版), 2017, 11(2): 102-105.
15.	陈丽莉, 何惠燕, 毛晓群. 乳腺癌患者应用植入式中心静脉输液港的常见问题与对策. 中华护理杂志, 2011, 46(11): 1116-1117.
16.	毕铁强, 周军, 汪瑞, 等. 完全植入式静脉输液港与经外周静脉穿刺中心静脉置管在乳腺癌患者化疗中的应用效果比较. 中华乳腺病杂志(电子版), 2014, 8(2): 103-108.
17.	Taxbro K, Hammarskjöld F, Thelin B, et al. Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer: an open-label, randomised, two-centre trial. Br J Anaesth, 2019, 122(6): 734-741.
18.	Sousa B, Furlanetto J, Hutka M, et al. Central venous access in oncology: ESMO clinical practice guidelines. Ann Oncol, 2015, 26 Suppl 5: 152-168.
19.	Schiffer CA, Mangu PB, Wade JC, et al. Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol, 2013, 31(10): 1357-1370.
20.	Lancsar E, Louviere J. Conducting discrete choice experiments to inform healthcare decision making: a user's guide. Pharmacoeconomics, 2008, 26(8): 661-677.
21.	Pearmain D, Swanson J, Kroes E, et al. Stated preference techniques: a guide to practice (2nd ed). London: Steer Davies Gleave and Hague Consulting Group Press, 1991.
22.	Train KB. Discrete choice methods with simulation (2nd edition). Cambridge: Cambridge University Press, 2009.
23.	Lancsar E, Louviere J, Flynn T. Several methods to investigate relative attribute impact in stated preference experiments. Soc Sci Med, 2007, 64(8): 1738-1753.
24.	刘运江, 屈翔, 葛智成, 等. 乳腺癌植入式静脉输液港临床应用专家共识及技术操作指南(2017版). 中国实用外科杂志, 2017, 37(12): 1377-1382.
25.	罗祎, 石磊, 江智霞, 等. 植入式静脉输液港与经外周静脉穿刺中心静脉置管在肿瘤化疗中的应用效果评价. 中国实用护理杂志, 2015, 31(22): 1681-1685.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 李宜臻, 郑怡, 邓玉皎, 等. 1990~2019年中国女性乳腺癌疾病负担及危险因素研究. 中国循证医学杂志, 2021, 21(8): 876-881.
3. 中心静脉血管通路装置安全管理专家组. 中心静脉血管通路装置安全管理专家共识(2019版). 中华外科杂志, 2020, 58(4): 261-272.
4. 王凯蓉, 周英凤. PICC与CVC, VPA经济学评价研究的系统评价. 护理学杂志, 2019, 34(8): 54-58.
5. 徐凤银, 李惠芬, 李松琴, 等. 三种不同类型中心静脉导管感染临床特点分析. 齐鲁护理杂志, 2019, 25(13): 31-34.
6. 徐文洁, 闻曲, 成芳, 等. 植入式静脉输液港与PICC临床应用现状比较. 中国护理管理, 2013, 13(12): 102-103.
7. Clark MD, Determann D, Petrou S, et al. Discrete choice experiments in health economics: a review of the literature. Pharmacoeconomics, 2014, 32(9): 883-902.
8. de Bekker-Grob EW, Ryan M, Gerard K. Discrete choice experiments in health economics: a review of the literature. Health Econ, 2012, 21(2): 145-172.
9. Soekhai V, de Bekker-Grob EW, Ellis AR, et al. Discrete choice experiments in health economics: past, present and future. Pharmacoeconomics, 2019, 37(2): 201-226.
10. Thurstone LL. A law of comparative judgment. Psychol Rev, 1994, 101(2): 266-270.
11. McFadden D. Conditional logit analysis of qualitative choice behavior. New York: Academic Press, 1974.
12. 胡婉侠, 徐文华, 徐建光, 等. 我国卫生领域离散选择实验应用研究的文献计量分析. 南京医科大学学报(社会科学版), 2020, 20(2): 157-161.
13. 刘世蒙, 夏志远, 魏艳, 等. 离散选择实验在中心静脉输液装置选择偏好中的需求及应用分析. 中国药物经济学, 2021, 16(1): 5-9.
14. 陈莉, 罗凤, 蔡明. 植入式静脉输液港并发症及处理的研究进展. 中华乳腺病杂志(电子版), 2017, 11(2): 102-105.
15. 陈丽莉, 何惠燕, 毛晓群. 乳腺癌患者应用植入式中心静脉输液港的常见问题与对策. 中华护理杂志, 2011, 46(11): 1116-1117.
16. 毕铁强, 周军, 汪瑞, 等. 完全植入式静脉输液港与经外周静脉穿刺中心静脉置管在乳腺癌患者化疗中的应用效果比较. 中华乳腺病杂志(电子版), 2014, 8(2): 103-108.
17. Taxbro K, Hammarskjöld F, Thelin B, et al. Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer: an open-label, randomised, two-centre trial. Br J Anaesth, 2019, 122(6): 734-741.
18. Sousa B, Furlanetto J, Hutka M, et al. Central venous access in oncology: ESMO clinical practice guidelines. Ann Oncol, 2015, 26 Suppl 5: 152-168.
19. Schiffer CA, Mangu PB, Wade JC, et al. Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol, 2013, 31(10): 1357-1370.
20. Lancsar E, Louviere J. Conducting discrete choice experiments to inform healthcare decision making: a user's guide. Pharmacoeconomics, 2008, 26(8): 661-677.
21. Pearmain D, Swanson J, Kroes E, et al. Stated preference techniques: a guide to practice (2nd ed). London: Steer Davies Gleave and Hague Consulting Group Press, 1991.
22. Train KB. Discrete choice methods with simulation (2nd edition). Cambridge: Cambridge University Press, 2009.
23. Lancsar E, Louviere J, Flynn T. Several methods to investigate relative attribute impact in stated preference experiments. Soc Sci Med, 2007, 64(8): 1738-1753.
24. 刘运江, 屈翔, 葛智成, 等. 乳腺癌植入式静脉输液港临床应用专家共识及技术操作指南(2017版). 中国实用外科杂志, 2017, 37(12): 1377-1382.
25. 罗祎, 石磊, 江智霞, 等. 植入式静脉输液港与经外周静脉穿刺中心静脉置管在肿瘤化疗中的应用效果评价. 中国实用护理杂志, 2015, 31(22): 1681-1685.

Chinese Journal of Evidence-Based Medicine

Preliminary analysis of preferences and willingness to pay for central venous access in patients with breast cancer

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