Bias in valuation of health care benefits in metastatic prostate cancer: A contingent valuation of willingness to pay.

Abstract

6616 Background: Willingness to pay (WTP) studies assess societal valuation of healthcare interventions. Prostate cancer (PC) is the most common cancer diagnosis in men. We explore factors that may bias valuation of health care benefits through contingent valuation of WTP for therapeutic innovation in metastatic castration-resistant PC. Methods: Cross-sectional study of Portuguese Society (SOC) and Healthcare Providers (HCP). Monthly WTP assessed through biding and open-ended questions by standardized survey with 2 baseline scenarios: ScA 12-month median survival, ScB 30-month median survival. Respondents considered own financial resources and expenses and for each therapeutic scenario reported WTP, out-of-pocket, and expected National Healthcare System (NHCS) WTP. Impact of demographic, personal medical history and household income assessed by tweedie generalized linear model. Results: 1000 subjects on societal cohort and 100 physicians provided valid responses. Subjects reported higher WTP values when NHCS was to provide treatment compared to out-of-pocket cost. For NHCS perspective median WTP for ScA was 2,133€ for HCP vs 5,510€ for SOC and ScB 1 963€ for HCP vs 5,479€ for SOC. Overall, societal cohort’s NHCS mean WTP was 2.6 (ScA) and 2.8 (ScB) times higher (p < .001) than healthcare providers, but with no difference for out-of-pocket WTP. This difference remained significant when adjusted for all other factors. Additionally, subjects with prior personal or familial history of cancer and subjects with higher household income provided higher WTP estimates. In HCP cohort, urologists reported higher WTP compared to Medical Oncologists. Conclusions: This study provides critical insight into differing valuation of cancer treatments between physicians and society and potential biases in individual valuation of healthcare benefits. Improvement of societal’s perception and understanding of cost-benefit assessments is critical to designing an equitable healthcare system.

Willingness-to-pay for cancer treatment and outcome: a systematic review

“…The database search identified 5912 records while an additional 4 records were identified through citation tracking. Fifty-four studies (including 12 conference abstracts [32][33][34][35][36][37][38][39][40][41][42][43] and one research letter [44]) were included after screening 3309 abstracts and 86 full-text articles. Thirty-two articles were excluded as per the reasons stated in Fig.…”