What determines patient preferences for treating low risk basal cell carcinoma when comparing surgery vs imiquimod? A discrete choice experiment survey from the SINS trial

Michela Tinelli,Mara Ozolins,Hywel C Williams,Fiona Bath-Hextall

doi:10.1186/1471-5945-12-19

Michela Tinelli, Mara Ozolins + Show 2 more

Open Access

https://doi.org/10.1186/1471-5945-12-19

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Abstract

BackgroundThe SINS trial (Controlled Clinical Trials ISRCTN48755084; Eudract No. 2004-004506-24) is a randomised controlled trial evaluating long term success of excisional surgery vs. imiquimod 5% cream for low risk nodular and superficial basal cell carcinoma (BCC). The trial included a discrete choice experiment questionnaire to explore patient preferences of a cream versus surgery for the treatment of their skin cancer.MethodsThe self-completed questionnaire was administered at baseline to 183 participants, measuring patients’ strength of preferences when choosing either alternative ‘surgery’ or ‘imiquimod cream’ instead of a fixed ‘current situation’ option (of surgical excision as standard practice in UK). The treatments were described according to: cost, chance of complete clearance, side effects and appearance. Participants had to choose between various scenarios. Analysis was performed using a mixed logit model, which took into account the impact of previous BCC treatment and sample preference variability.ResultsThe analysis showed that respondents preferred ‘imiquimod cream’ to their ‘current situation’ or ‘surgery’, regardless of previous experience of BCC symptoms and treatment. Respondents were more likely to be worried about their cosmetic outcomes and side effects they might experience over and above their chance of clearance and cost. Those with no experience of surgery (compared with experience) valued more the choice of ‘imiquimod cream’ (£1013 vs £781). All treatment characteristics were significant determinants of treatment choice, and there was significant variability in the population preferences for all of them.ConclusionsPatients with BCC valued more ‘imiquimod cream’ than alternative ‘surgery’ options, and all treatment characteristics were important for their choice of care. Understanding how people with a BCC value alternative interventions may better inform the development of health care interventions.

Highlights

The SINS trial (Controlled Clinical Trials ISRCTN48755084; Eudract No 2004-004506-24) is a randomised controlled trial evaluating long term success of excisional surgery vs. imiquimod 5% cream for low risk nodular and superficial basal cell carcinoma (BCC)
To make an informed choice when choosing between surgery and imiquimod cream treatments for low risk basal cell carcinomas (BCCs) such as superficial BCC or small nodular BCC not located on the central face
We chose the Discrete Choice Experiments (DCEs) technique as it has been previously used in health care to evaluate different cancer screening strategies (Wordsworth et al [6]; Marshall et al [7]; Kruijshaar et al [8]; van Dam et al [9]; Hol et al [10]); and willingness to pay (WTP) for methyl aminolevulinate photodynamic therapy vs surgery in BCC (Weston and Fitzgerald [2]) and for Mohs micrographic surgery vs surgery (Essers et al [3])

Summary

Introduction

The SINS trial (Controlled Clinical Trials ISRCTN48755084; Eudract No 2004-004506-24) is a randomised controlled trial evaluating long term success of excisional surgery vs. imiquimod 5% cream for low risk nodular and superficial basal cell carcinoma (BCC). The trial included a discrete choice experiment questionnaire to explore patient preferences of a cream versus surgery for the treatment of their skin cancer. Our aim was to investigate patient preferences for ‘surgery’ or ‘imiquimod cream’ for the treatment of BCC using a discrete choice experiment (DCE; Ryan et al [4]) approach in a sample of patients participating in a randomised controlled trial of surgery vs imiquimod for low risk nodular and superficial BCC We chose the Discrete Choice Experiments (DCEs) technique as it has been previously used in health care to evaluate different cancer screening strategies (Wordsworth et al [6]; Marshall et al [7]; Kruijshaar et al [8]; van Dam et al [9]; Hol et al [10]); and willingness to pay (WTP) for methyl aminolevulinate photodynamic therapy vs surgery in BCC (Weston and Fitzgerald [2]) and for Mohs micrographic surgery vs surgery (Essers et al [3]). This study investigates how patients with a low risk BCC participating in a randomized controlled trial of excisional surgery versus topical imiquimod value the choice between the two treatment modalities

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