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Original research article
Individual preferences on the balancing of good and harm of cardiovascular disease screening
  1. Tina Birgitte Hansen1,2,
  2. Jes Sanddal Lindholt3,4,
  3. Axel Cosmus Pyndt Diederichsen4,5,
  4. Michiel C J Bliemer6,
  5. Jess Lambrechtsen7,
  6. Flemming Hald Steffensen8,
  7. Rikke Søgaard9,10
  1. 1 Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
  2. 2 Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
  3. 3 Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
  4. 4 Elitary Research Unit of Personalized Medicine in Arterial Disease (CIMA), Odense University Hospital, Odense, Denmark
  5. 5 Department of Cardiology, Odense University Hospital, Odense, Denmark
  6. 6 Institute of Transport and Logistics Studies, University of Sydney Business School, Sydney, New South Wales, Australia
  7. 7 Department of Cardiology, University Hospital Odense, Odense, Denmark
  8. 8 Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
  9. 9 Department of Public Health, Aarhus University, Aarhus, Denmark
  10. 10 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  1. Correspondence to Dr Tina Birgitte Hansen, Department of Cardiology, Zealand University Hospital, Roskilde, Denmark; tbh{at}


Objective Transition towards value-based healthcare requires insight into what makes value to the individual. The aim was to elicit individual preferences for cardiovascular disease screening with respect to the difficult balancing of good and harm as well as mode of delivery.

Methods A discrete choice experiment was conducted as a cross-sectional survey among 1231 male screening participants at three Danish hospitals between June and December 2017. Participants chose between hypothetical screening programmes characterised by varying levels of mortality risk reduction, avoidance of overtreatment, avoidance of regretting participation, screening duration and location. A multinomial mixed logit model was used to model the preferences and the willingness to trade mortality risk reduction for improvements on other characteristics.

Results Respondents expressed preferences for improvements on all programme characteristics. They were willing to give up 0.09 (95% CI 0.08 to 0.09) lives saved per 1000 screened to avoid one individual being over treated. Similarly, respondents were willing to give up 1.22 (95% CI 0.90 to 1.55) or 5.21 (95% CI 4.78 to 5.67) lives saved per 1000 screened to upgrade the location from general practice to a hospital or to a high-tech hospital, respectively. Subgroup analysis revealed important preference heterogeneity with respect to smoking status, level of health literacy and self-perceived risk of cardiovascular disease.

Conclusions Individuals are able to express clear preferences about what makes value to them. Not only health benefit but also time with health professionals and access to specialised facilities were important. This information could guide the optimal programme design in search of value-based healthcare.

  • quality and outcomes of care
  • cardiac risk factors and prevention

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  • Contributors TBH and RS conceived the idea for the study. All the authors contributed to the design and planning of the study. TBH, MCJB and RS performed the statistical analyses. TBH wrote the first draft of the manuscript. All revised the manuscript critically. All have given their final approval of the version to be published. TBH and RS are responsible for the overall content.

  • Funding The randomised trial from which the participants in the current study was recruited has received financial support from the South Region of Denmark, the Danish Research Council, the Danish Heart Foundation, the Helse Foundation, Odense University Hospital and the Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA). For the DCE study, financial support has been provided by the Region Zealand (RSSF2017000614).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the Danish Data Protection Agency (REG-003-2017).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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