Assessments of the value of cancer therapies have been based on the assumption that stakeholders care most about average or median gain in survival or quality-adjusted survival. These assessments have ignored variability or spread around the average, or in more tangible terms, a chance (albeit possibly small) at a large and highly meaningful gain in survival. A recent survey investigated hypothetical scenarios to assess the value that patients place on promising, although unproven, cancer therapies (Lakdawalla DN, et al. Health Aff [Millwood]. 2012;31:676-682).
The investigators surveyed 150 patients with cancer who were undergoing radiation, chemotherapy, or “watchful waiting.” The survey was conducted at 5 sites within a national network of community-based oncology practices.
Survey questions involved “hopeful gamble” and “safe bet” hypothetical treatment scenarios, asking patients which treatment they would prefer, and how much they would be willing to pay for it. The hopeful gamble provides a chance of a bigger survival benefit, but also a worse potential downside. The safe bet offers similar survival duration but a reduced chance for a large gain.
The results showed that 77% of the survey participants would prefer a hopeful, unproven therapy to a sure bet in the hope of a potentially greater benefit. These patients were willing to pay $54,362 for the hopeful therapy rather than the evidence-based alternative; the average patient would pay $36,305 for a 1-year increase in survival (standard deviation).
The investigators acknowledged that these results would not necessarily be identical to real-world decisions in terms of how much patients would be willing or able to pay for such therapies; however, these results do point to the need to address the patient’s perspective and to consider long-term benefits in assessing the value of cancer therapies.
