ORIGINAL ARTICLE Women and their partners’ preferences for Down’s syndrome screening tests: a discrete choice experiment Fran E. Carroll 1 *, Hareth Al-Janabi 2 , Terry Flynn 3 and Alan A. Montgomery 1 1 School of Social and Community Medicine, University of Bristol, England, UK 2 Health Economics Unit, School of Health and Population Sciences, University of Birmingham, England, UK 3 Centre for the Study of Choice, University of Technology, Sydney, Australia *Correspondence to: Fran E. Carroll. E-mail: fran.carroll@bristol.ac.uk ABSTRACT Objectives This study aimed to determine quantitatively the attributes of such screening tests that couples placed most value on. Methods A stated preference discrete choice experiment was conducted among a sample of pregnant women and their male partners. One four-level attribute (cost) and three two-level attributes (detection rate, gestation and time to wait for results) were used to generate eight hypothetical pairs of tests. Results A total of 103 participants fully completed the questionnaire (63 women, 40 men). Overall, the sample was most concerned with test cost. However, latent class analysis showed three groups of participants whose concern for attributes differed, with cost, detection rate and delay in receiving results being the most important to each. Willingness to pay calculations showed that participants who were most concerned with detection rate were prepared to pay more than four times the amount than those most cost-sensitive would pay for the ‘best test’ option as compared with the ‘worst test’. Conclusions Overall, couples were sensitive to the price of the screening test, but explicit subgroups are also shown that would pay large amounts for improvements in other attributes, particularly detection rates. This could provide important information to policymakers and practitioners in antenatal care, specifically in relation to the trade-offs made when couples decide about antenatal screening tests. © 2013 John Wiley & Sons, Ltd. Funding sources: This study was funded by the Medical Research Council as part of a 4-year PhD Studentship awarded to the primary author (FC). Financial support for this study was provided entirely by this studentship. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing and publishing the report. Conflicts of interest: None declared INTRODUCTION Recent health services research literature reflects a growing interest in understanding how patients make decisions surrounding healthcare options and what their preferences are for their care. 1 Screening during pregnancy is an area of maternity care where different options are available and as such parents-to- be are required to make decisions. Antenatal screening for Down’s syndrome (DS) is routinely available in many countries; for example, in many European countries and the USA, some form of screening is offered to all pregnant women. 2,3 In the UK, it is offered to all women as part of the National Health Service (NHS) antenatal care, 4 and in some areas, there is an option to access a test with a higher detection rate (although similarly accurate) in the private sector (OSCAR test – One Stop Clinic for Assessment of Risk), incurring a cost of approximately £200. Screening tests are non-invasive and not physically harmful to mother or baby. 5 These tests provide pregnant women and their partners with a risk estimate of their current pregnancy being affected by DS. To provide a definitive diagnosis of DS, however, an invasive diagnostic test such as amniocentesis or chorionic villus sampling must be conducted. The screening and testing process is optional, so the first decision to be made is whether to undergo any screening. If screening suggests a high risk of an anomaly (current cut-off: >1 in 150), 6 then a decision must be made about whether or not to have invasive diagnostic testing that is associated with a 1% to 2% procedural risk of miscarriage. 4 If an anomaly is diagnosed, this may then require a decision about pregnancy termination. These may be emotive and potentially difficult decisions, and it is important that parents-to-be are fully informed of the process and potential outcomes. 7 Informed choices are Prenatal Diagnosis 2013, 33,1–8 © 2013 John Wiley & Sons, Ltd. DOI: 10.1002/pd.4086