Maximising Participation in the Australian National Lung Cancer Screening Program: A Discrete Choice Experiment of...

Relatively little is known about how to maximise participation in lung cancer screening for Australians at high risk of developing the disease. A discrete choice experiment was conducted to elicit and quantify preferences of Australians eligible for lung cancer screening (LCS) to maximise participation in the National Lung Cancer Screening Program (NLCSP) and estimate likely participation.

Respondents completed an online survey of six LCS factors or 'attributes' (invitation to screen, eligibility assessment, appointment booking, model of care, health care worker support and out-of-pocket costs). Results were analysed using mixed logit (MIXL), multinomial logit (MNL) and latent class analysis to explore heterogeneity in respondents' choices. Willingness to pay (WTP) for screening attributes were estimated based on the ratio of the coefficient on attributes to cost.

Respondents (n = 757) were aged 50-70 years with smoking histories (> 30 pack-year history and either currently smoke or quit ≤ 10 years). The MIXL showed that participants preferred support from a program navigator, with the highest estimated WTP of $24, plus personalised invitations and lower screening costs. The results identified participation rates that could be achieved through optimal LCS program design, across the most optimistic screening program scenario (87.4%), the scenario proposed in the NLCSP (51.5%) and the least preferred scenario (35.0%).

The results are highly relevant for the NLCSP, which commenced on 1 July 2025. Potential participants place significant value on program navigators, a role not funded within the program, which could significantly improve uptake.