Australian Preferences for Prenatal Screening: A Discrete Choice Experiment Comparing Metropolitan and Rural/Regional Areas

Amber Salisbury; Sarah Norris; Alison Pearce; Kirsten Howard

doi:10.1007/s40258-024-00938-5

Australian Preferences for Prenatal Screening: A Discrete Choice Experiment Comparing Metropolitan and Rural/Regional Areas

Appl Health Econ Health Policy. 2025 Jan 17. doi: 10.1007/s40258-024-00938-5. Online ahead of print.

Authors

Amber Salisbury^{1

2}, Sarah Norris³, Alison Pearce^{4

5}, Kirsten Howard³

Affiliations

¹ Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. [email protected].
² The Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia. [email protected].
³ Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
⁴ The Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia.
⁵ Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.

PMID: 39820883
DOI: 10.1007/s40258-024-00938-5

Abstract

Background: Non-invasive prenatal testing has the potential to be a useful genetic screening tool in Australia. However, concerns have been raised about its cost, commercial provision, the psychological impacts of the screening process, and disparities in access experienced by rural and regional communities.

Aims: The aims of this study are (1) to estimate Australian preferences for features of prenatal screening; (2) to explore potential variations in preferences between metropolitan and rural/regional communities; (3) to estimate the extent to which respondents are willing to trade-off between attributes, using willingness to pay (WTP) and willingness to wait estimates.

Methods: A discrete choice experiment (DCE) was conducted with 12 choice tasks. The DCE recruited participants from metropolitan (n = 160) and rural/regional (n = 168) locations across Australia. Mixed logit and latent class analyses were conducted and WTP and willingness to wait were calculated.

Results: Both metropolitan and rural/regional preferences were significantly impacted by the false-positive rate, false-negative rate, and cost. In addition, rural preferences were significantly impacted by the scope of the conditions covered, the inconclusive rate, and wait times. The number of screening tests and revealing the sex of the foetus were not significant within either group. Willingness to pay estimates ranged from AU$13 to avoid a test with a 1% increase in the false-positive rate to AU$323 to screen for a wide range of conditions.

Conclusions: This study highlights the importance of considering differing preferences between rural and metropolitan populations when delivering prenatal screening. Further, this study provides Australian-specific WTP estimates to be incorporated into economic evaluations.