Immunotargeted therapy in melanoma: patient, provider preferences, and willingness to pay at an academic cancer center

作者：David D. Stenehjem, Trang H. Au, Surachat Ngorsuraches, Junjie Ma, Hillevi Bauer, Tanatape Wanishayakorn, Ryan Nelson, Constance Pfeiffer, Joshua Schwartz, Beata Korytowsky, Gary M. Oderda, Diana Brixner · 发表于：Melanoma Research · 年份：2019 · DOI：10.1097/cmr.0000000000000572 · 被引用次数：31 · 研究领域：Health Systems, Economic Evaluations, Quality of Life、Cutaneous Melanoma Detection and Management

New melanoma therapies have shifted the expectations of patients and providers. Evaluating the impact of treatment characteristics may enhance shared decision making. A survey, including a discrete choice experiment, was utilized to evaluate perceived trade-offs of different melanoma treatments and to estimate out-of-pocket (OOP) willingness-to-pay (WTP) thresholds (January 2016 to March 2016). Participants included patients with melanoma at Huntsman Cancer Institute and their cancer care providers. Stakeholder focus groups were conducted to identify treatment attributes. Descriptive and comparative statistics and multinomial logit model were used to evaluate responses. Response rates were 41.9% (N = 220) for patients and 37.7% (N = 20) for providers. Immunotherapy and targeted therapy attributes considered important by participants were overall survival, immunotherapy-related side effects, and skin toxicities. Patients and providers had significantly different views of quality-of-life expectations, anxiety toward melanoma, trust to make treatment decisions, sharing concerns about treatment, time to discuss treatment, understanding OOP costs, and willingness to undergo/recommend treatment (half of the patients would undergo treatment if it was effective for > 24 months). Among patients, the average monthly OOP WTP for combination immunotherapy with nivolumab + ipilimumab was $ 2357 and for BRAF/MEK inhibitor was $1648. Among providers, these estimates were $ 2484 and $1350, r...