What Matters Most to Women in Breast Biopsy? A Discrete Choice Experiment in Italy
Author(s)
Ludovico Cavallaro, MSc1, Carla Rognoni, PhD1, Rosanna Tarricone, PhD2.
1Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy, 2Department of Social and Political Sciences, Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy.
1Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy, 2Department of Social and Political Sciences, Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy.
OBJECTIVES: Understanding how women value different aspects of breast biopsy is essential to developing more patient-centred diagnostic pathways. This study aimed to elicit preferences and willingness-to-pay of adult women in Italy for key attributes of diagnostic-therapeutic breast biopsy.
METHODS: A binary discrete choice experiment (DCE) was administered to adult women (≥18 years) in Italy with the support of a national umbrella patient association. The study was approved by the Ethics Committee of Bocconi University. An Optimal Orthogonal in the Differences (OOD) design was generated using Ngene to construct 72 choice sets. Each respondent completed 9 choice tasks, comparing two clinically equivalent biopsy options differing across five attributes: 1) post-procedural pain (mild, moderate, severe); 2) type of anaesthesia (local, general); 3) presence of visible scarring (yes, no); 4) hospitalisation (day surgery, overnight stay); and 5) out-of-pocket cost (€0, €50, €100). Attributes and levels were defined through literature review and consultations with clinicians and patients. A mixed logit model was used to analyse responses in Stata 18.5.
RESULTS: A total of 339 questionnaires were collected between May and June 2025. Most respondents were aged 45-64 years (60.5%), had previous biopsy experience (67.3%), and resided in Northern Italy (65.7%). All attribute coefficients were statistically significant (p < 0.001). The greatest disutility was associated with severe post-procedural pain, followed by visible scarring and general anaesthesia. Moderate pain and overnight hospitalisation were also relevant, though to a lesser extent. Some preference heterogeneity was observed by socio-demographic characteristics. For instance, older women showed greater aversion to general anaesthesia and were comparatively less concerned about visible scarring.
CONCLUSIONS: In the context of breast biopsy, Italian women valued the avoidance of severe pain most, followed by visible scarring and general anaesthesia. Integrating these preferences into diagnostic pathways may improve the acceptability of the procedure and contribute to the implementation of value-based healthcare.
METHODS: A binary discrete choice experiment (DCE) was administered to adult women (≥18 years) in Italy with the support of a national umbrella patient association. The study was approved by the Ethics Committee of Bocconi University. An Optimal Orthogonal in the Differences (OOD) design was generated using Ngene to construct 72 choice sets. Each respondent completed 9 choice tasks, comparing two clinically equivalent biopsy options differing across five attributes: 1) post-procedural pain (mild, moderate, severe); 2) type of anaesthesia (local, general); 3) presence of visible scarring (yes, no); 4) hospitalisation (day surgery, overnight stay); and 5) out-of-pocket cost (€0, €50, €100). Attributes and levels were defined through literature review and consultations with clinicians and patients. A mixed logit model was used to analyse responses in Stata 18.5.
RESULTS: A total of 339 questionnaires were collected between May and June 2025. Most respondents were aged 45-64 years (60.5%), had previous biopsy experience (67.3%), and resided in Northern Italy (65.7%). All attribute coefficients were statistically significant (p < 0.001). The greatest disutility was associated with severe post-procedural pain, followed by visible scarring and general anaesthesia. Moderate pain and overnight hospitalisation were also relevant, though to a lesser extent. Some preference heterogeneity was observed by socio-demographic characteristics. For instance, older women showed greater aversion to general anaesthesia and were comparatively less concerned about visible scarring.
CONCLUSIONS: In the context of breast biopsy, Italian women valued the avoidance of severe pain most, followed by visible scarring and general anaesthesia. Integrating these preferences into diagnostic pathways may improve the acceptability of the procedure and contribute to the implementation of value-based healthcare.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PCR268
Topic
Economic Evaluation, Patient-Centered Research
Disease
Oncology