Cost Sharing and Hereditary Cancer Risk: Predictors of Willingness‐to‐Pay for Genetic Testing. Issue 6 (6th May 2014)

• Record Type: Journal Article
• Authors: Matro, Jennifer M.; Ruth, Karen J.; Wong, Yu‐Ning; McCully, Katen C.; Rybak, Christina M.; Meropol, Neal J.; Hall, Michael J.
• Is Part Of: Journal of genetic counseling. Volume 23:Issue 6(2014)
• Page Start: 1002
• Page End: 1011
• Publication Date: 2014-05-06
• Subjects: Willingness‐to‐pay -- Genetic testing -- Gastrointestinal -- Risk -- Colorectal cancer; Genetic counseling -- Periodicals; 616.042
• DOI: 10.1007/s10897-014-9724-5
• Languages: English
• ISSNs: 1059-7700

Abstract

Abstract: Increasing use of predictive genetic testing to gauge hereditary cancer risk has been paralleled by rising cost‐sharing practices. Little is known about how demographic and psychosocial factors may influence individuals' willingness‐to‐pay for genetic testing. The Gastrointestinal Tumor Risk Assessment Program Registry includes individuals presenting for genetic risk assessment based on personal/family cancer history. Participants complete a baseline survey assessing cancer history and psychosocial items. Willingness‐to‐pay items include intention for: genetic testing only if paid by insurance; testing with self‐pay; and amount willing‐to‐pay ($25–$2, 000). Multivariable models examined predictors of willingness‐to‐pay out‐of‐pocket (versus only if paid by insurance) and willingness‐to‐pay a smaller versus larger sum (≤$200 vs. ≥$500). All statistical tests are two‐sided (α = 0.05). Of 385 evaluable participants, a minority (42 %) had a personal cancer history, while 56 % had ≥1 first‐degree relative with colorectal cancer. Overall, 21.3 % were willing to have testing only if paid by insurance, and 78.7 % were willing‐to‐pay. Predictors of willingness‐to‐pay were: 1) concern for positive result; 2) confidence to control cancer risk; 3) fewer perceived barriers to colorectal cancer screening; 4) benefit of testing to guide screening (all p < 0.05). Subjects willing‐to‐pay a higher amount were male, more educated, had greater cancer worry, fewer relatives with colorectal cancer, and more positive attitudes toward genetic testing (all p < 0.05). Individuals seeking risk assessment are willing‐to‐pay out‐of‐pocket for genetic testing, and anticipate benefits to reducing cancer risk. Identifying factors associated with willingness‐to‐pay for genetic services is increasingly important as testing is integrated into routine cancer care.