Therapy preferences in melanoma treatment—Willingness to pay and preference of quality versus length of life of patients, physicians, healthy individuals and physicians with oncological disease

Abstract

Background In recent years, monoclonal antibodies such as ipilimumab, nivolumab, and pembrolizumab have made a significant impact on the treatment of advanced melanoma. Combination of immune checkpoint inhibitors leads to improved survival and response rates of 58%‐61% as compared to monotherapy (36%‐44%). However, the price for the better response rates is also a higher frequency of severe adverse events (59%) as compared to monotherapy (17%‐21%). This study examines attitudes towards melanoma therapy options of physicians, healthy individuals, melanoma patients, and physicians with oncological disease, their willingness to pay, and preference of quality versus length of life. Methods After obtaining ethical approval and informed consent surveys were conducted in 111 participants divided into four groups: melanoma patients (n = 30), healthy individuals as controls (n = 30), physicians (n = 27), and physicians with oncological disease (n = 24). Statistical analyses were conducted using SPSS statistics (version 25, IBM), applying the Pearson´s chi‐squared test, Spearman correlation coefficient, Wilcoxon‐Mann‐Whitney test, and Kruskal‐Wallis test. Results Life prolongation is more valued by melanoma patients and physicians with oncological disease compared to healthy controls and healthy physicians. In total, 30% of melanoma patients opt for a life prolonging therapy in all cases, even if this life prolongation is only marginal. Physicians are the strongest proponents of combination immunotherapy. Conclusion The valuation of the different treatment options differs in the four study groups with affected people valuing life prolongation much more. The individual value of cancer therapies is high, but differs from the societal standpoint.

Methodological challenges and potential solutions for economic evaluations of palliative and end-of-life care: A systematic review

“…17,20,24–26,52,53,62,64,73,76,90,94–96 Other methodological challenges identified related to ambiguous and inaccurate patient identification, 15,45,67–70,76,85,94,96 –99 restricted generalisability due to poor geographic transferability of evidence, 16,40,42,43,52,53,60,71,85,96,98 difficulties defining comparators, 15,97 consequences of applied time horizon, 65 challenged outcome measurement 35,45,57,89,97,100 and challenges regarding a reliable preference-based outcome valuation. 37,45,58,59,66,72,84,85,87,101 –105…”

“…Authors' opinions, study outcomes and national costing guidelines are inconclusive on the appropriateness of assigning higher weight to end-of-life health gains. 63,102,103 While new approaches have been introduced and more methodological studies conducted, 58,59,66 overall, empirical support is limited and further research is needed in this field. 101,104 Furthermore, individuals may value aspects of care in a way that contradicts the underlying quality paradigm.…”

Cost-effectiveness of Response-Adapted De-escalation of Immunotherapy in Advanced Melanoma

“…The lack of funding and the competition for accrual through sponsored trials result in few successful de-escalation trials . Of note, patient preferences are often not considered in these trials, despite evidence that patients may value fewer infusions in lieu of optimal disease control …”

How aging of the global population is changing oncology

“…The decision-making style of each older cancer patient will vary, ranging from independent to passive [ 120 ], but emotion remains a significant factor [ 121 ] with reassurance a frequent need [ 122 ]. This hints at the influence of incrementalist thinking among patients with cancer, such that even a one-month survival gain persuades many to request more toxic treatments [ 123 ], presumably due to fear [ 124 ]. Most patients worry about disease recurrence, and look to their oncologist as the ultimate defender against such contingencies [ 125 , 126 ]; the mantra of whatever can be done will be done, and only the best is good enough, thus becomes a path of least resistance for physicians, and is further reinforced by litigation concerns.…”