Societal Preferences, Values and Priorities for Genomic Testing for Atrial Fibrillation: Evidence from Two Discrete Choice Experiments

BACKGROUND AND OBJECTIVE: Atrial fibrillation is the most common sustained cardiac arrhythmia and is associated with an increased risk of stroke, heart failure and death. Genetic factors can contribute to atrial fibrillation pathogenesis and have the potential for atrial fibrillation risk stratification and clinical management. Using stated preference methods, this paper provides the first empirical evidence on consumer preferences, values and priorities for genomic testing in atrial fibrillation. METHODS: Two discrete choice experiment surveys were designed and administered to the Australian public. Participants were asked to imagine situations where they either developed atrial fibrillation symptoms (symptomatic patients survey, n = 503) or had close family members diagnosed with atrial fibrillation (at-risk relatives survey, n = 506). Each participant was given 12 hypothetical scenarios involving five key aspects of genomic testing. Choice data were analysed using panel error component mixed logit and latent class models. RESULTS: The two most valued benefits were clinical implications for monitoring personal cardiac complications other than atrial fibrillation and health implications for other family members. Cost was the main driver of preferences for testing. The value of genomic testing was estimated at $2900 for symptomatic patients and approximately 10% less for at-risk relatives. Uptake was predicted at around 82% for both groups if the test was publicly funded. People of lower financial or educational status and people without private health insurance were less likely to take-up genomic testing. CONCLUSIONS: Genomic testing for atrial fibrillation has perceived value for symptomatic patients and at-risk relatives. Tailored educational programmes and targeted support are essential to improve access for socioeconomically disadvantaged groups.