PUBLIC PREFERENCES FOR LUNG NODULE BIOPSY AHEAD OF NATIONAL LUNG CANCER SCREENING: A UK DISCRETE CHOICE EXPERIMENT
Author(s)
James Lavin, BSc1, Joana Pestana, PhD2, Frank O'Neill, PhD3, Rachele Busca, PharmD, Msc1, Cecilia Pompili, MD PhD FACS FEHA4.
1Intuitive Surgical Sarl, Aubonne, Switzerland, 2Intuitive Surgical GmbH, Freiburg, Germany, 3Intuitive Surgical, Wokingham, United Kingdom, 4University of Hull, Hull, United Kingdom.
1Intuitive Surgical Sarl, Aubonne, Switzerland, 2Intuitive Surgical GmbH, Freiburg, Germany, 3Intuitive Surgical, Wokingham, United Kingdom, 4University of Hull, Hull, United Kingdom.
OBJECTIVES: Lung cancer is the leading cause of cancer death in the UK, with poor survival driven by late diagnosis. Expanding low-dose CT screening increases early detection and biopsy demand. Selecting between robotic-assisted bronchoscopy (RAB) and CT-guided transthoracic needle aspiration (TTNA) is clinically important. These approaches differ in technique, complication risk, anaesthesia, pneumothorax requiring hospitalisation and repeat procedures, but evidence on how these attributes are valued is limited. We quantified UK public preferences for lung nodule biopsy attributes.
METHODS: A discrete choice experiment (DCE) was conducted in a representative UK general-population sample (N=223). Participants chose between biopsy options defined by method, anaesthesia, complication risk and repeat-biopsy probability, reflecting RAB and TTNA characteristics. Attributes were informed by literature and clinical input. Preferences were analysed with conditional and random parameter logit models, plus subgroup and latent class analyses. Time trade-off (TTO) and anxiety-based choice were included.
RESULTS: Respondents placed greatest weight on minimising complication risk (relative attribute importance RAI 55.2%) and avoiding repeat biopsy (RAI 37.6%); anaesthesia (6.3%) and biopsy method (0.8%) were less important. Latent class analysis identified a risk-averse segment prioritising safety and diagnostic certainty, consistent with the anxiety-based task. In the time trade-off exercise, willingness to undergo biopsy rather than wait increased from 58.3% to 67.7% as complication risk fell from 20% to 5%, with mean utility rising from 0.64 to 0.67.
CONCLUSIONS: This is the first UK DCE to quantify preferences distinguishing RAB and TTNA. The most valued factors, low complication risk and avoiding repeat biopsy, are where these approaches differ, with RAB offering TTNA-like yield at lower complication rates. Because patients prioritise outcomes over modality, biopsy selection should reduce avoidable harm by minimising complications and repeat procedures. As screening expands biopsy demand, findings support the patient-centred component of NICE evaluations. Confirmatory work in patients referred for lung nodule biopsy is warranted.
METHODS: A discrete choice experiment (DCE) was conducted in a representative UK general-population sample (N=223). Participants chose between biopsy options defined by method, anaesthesia, complication risk and repeat-biopsy probability, reflecting RAB and TTNA characteristics. Attributes were informed by literature and clinical input. Preferences were analysed with conditional and random parameter logit models, plus subgroup and latent class analyses. Time trade-off (TTO) and anxiety-based choice were included.
RESULTS: Respondents placed greatest weight on minimising complication risk (relative attribute importance RAI 55.2%) and avoiding repeat biopsy (RAI 37.6%); anaesthesia (6.3%) and biopsy method (0.8%) were less important. Latent class analysis identified a risk-averse segment prioritising safety and diagnostic certainty, consistent with the anxiety-based task. In the time trade-off exercise, willingness to undergo biopsy rather than wait increased from 58.3% to 67.7% as complication risk fell from 20% to 5%, with mean utility rising from 0.64 to 0.67.
CONCLUSIONS: This is the first UK DCE to quantify preferences distinguishing RAB and TTNA. The most valued factors, low complication risk and avoiding repeat biopsy, are where these approaches differ, with RAB offering TTNA-like yield at lower complication rates. Because patients prioritise outcomes over modality, biopsy selection should reduce avoidable harm by minimising complications and repeat procedures. As screening expands biopsy demand, findings support the patient-centred component of NICE evaluations. Confirmatory work in patients referred for lung nodule biopsy is warranted.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
P30
Topic
Medical Technologies, Methodological & Statistical Research, Patient-Centered Research
Disease
Oncology