Comparing the Relative Importance of Attributes of Metastatic Renal Cell Carcinoma Treatments to Patients and Physicians in the United States: A Discrete-Choice Experiment

González, Juan; Doan, Justin; Gebben, David J.; Boeri, Marco; Fishman, Mayer

doi:10.1007/s40273-018-0640-7

Cited by 17 publications

(22 citation statements)

References 34 publications

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“…Similar DCE studies in oncology that utilized online panels also reported study populations with relatively young mean ages (<55 years old). 42,43 We further explored this by comparing the RAISs between younger and older patients in our sample. Some differences in the importance ranking of attributes did change with respect to fatigue, rash, and cognitive problems, but the top two most important and two least important attributes remained the same (results not shown).…”

Section: T a B L E 2 (Continued)mentioning

confidence: 99%

Patient and caregiver benefit‐risk preferences for nonmetastatic castration‐resistant prostate cancer treatment

et al. 2020

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Background Recently approved second‐generation androgen receptor inhibitors (SGARIs) for non‐metastatic castration‐resistant prostate cancer (nmCRPC) have similar efficacy but differ in safety profiles. We used a discrete choice experiment (DCE) to examine how nmCRPC patients and caregivers perceive the benefits versus risks of these new treatments. Methods An online DCE survey with 14 treatment choice questions was administered to nmCRPC patients and caregivers. Each choice question compared two hypothetical medication profiles varying in terms of 5 safety attributes (risk or severity of adverse events [AEs]: fatigue, skin rash, cognitive problems, serious fall, and serious fracture) and two efficacy attributes (duration of overall survival [OS] and time to pain progression). Random parameters logit models were used to estimate each attribute's relative importance. We also estimated the amounts of OS that respondents were willing to forego for a reduction in AEs. Results In total, 143 nmCRPC patients and 149 caregivers viewed the AEs in following order of importance (most to least): serious fracture, serious fall, cognitive problems, fatigue, and skin rash. On average, patients were willing to trade 5.8 and 4.0 months of OS to reduce the risk of serious fracture and fall, respectively, from 3% to 0%; caregivers were willing to trade 6.6 and 5.4 months of OS. Conclusions nmCRPC patients and caregivers preferred treatments with lower AE burdens and were willing to forego OS to reduce the risk and severity of AEs. Our results highlight the importance of carefully balancing risks and benefits when selecting treatments in this relatively asymptomatic population.

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Section: T a B L E 2 (Continued)mentioning

confidence: 99%

Patient and caregiver benefit‐risk preferences for nonmetastatic castration‐resistant prostate cancer treatment

et al. 2020

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“…Therefore, given the lower value attributed to SAEs, oncologists were willing to accept a slightly higher increase in SAE risk than patients in exchange for 1-month survival gain (4.2% oncologists and 3.0% patients). In contrast, Gonzalez et al showed that although efficacy was the most important attribute for both physicians and patients, the former gave greater importance to fatigue, skin reactions or other attributes such as co-payment (22). These results would be in line with those observed by Lawrence et al, in which the survival times judged sufficient to warrant treatment (e.g.…”

Section: Discussionmentioning

confidence: 58%

“…Each of the treatments is associated with different clinical outcomes, administration modes, treatment-related adverse events, and costs (22), so decisions about therapy involve tradeoffs between the possible benefits and harms (9). The European Medicines Agency has indicated that in order to improve the management of treatment toxicities, it is important to better understand the extent to which patients are willing to tolerate AEs and, therefore, the relative importance patients give them (23).…”

Section: Introductionmentioning

confidence: 99%

Preferences for Renal Cell Carcinoma Pharmacological Treatment: A Discrete Choice Experiment in Patients and Oncologists

et al. 2022

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IntroductionThe purpose of this investigation was to explore patients’ and oncologists’ preferences for the characteristics of a pharmacological regimen for patients with advanced renal cell carcinoma (aRCC).Material and MethodsCross-sectional observational study based on a discrete choice experiment (DCE) conducted in Spain. A literature review, a focus group with oncologists and interviews with patients informed the DCE design. Five attributes were included: progression survival gain, risk of serious adverse events (SAEs), health-related quality of life (HRQoL), administration mode, and treatment cost. Preferences were analyzed using a mixed-logit model to estimate relative importance (RI) of attributes (importance of an attribute in relation to all others), which was compared between aRCC patients and oncologists treating aRCC. Willingness to pay (WTP, payer: health system) for a benefit in survival or in risk reduction and maximum acceptable risk (MAR) in SAEs for improving survival were estimated from the DCE. Subgroup analyses were performed to identify factors that influence preference.ResultsA total of 105 patients with aRCC (77.1% male, mean age 65.9 years [SD: 10.4], mean time since RCC diagnosis 6.3 years [SD: 6.1]) and 67 oncologists (52.2% male, mean age 41.9 years [SD: 8.4], mean duration of experience in RCC 10.2 years [SD: 7.5]) participated in the study. The most important attribute for patients and oncologists was survival gain (RI: 43.6% vs. 54.7% respectively, p<0.05), followed by HRQoL (RI: 35.5% vs. 18.0%, respectively, p<0.05). MAR for SAEs was higher among oncologists than patients, while WTP (for the health system) was higher for patients. Differences in preferences were found according to time since diagnosis and education level (patients) or length of professional experience (oncologists).ConclusionPatients’ and oncologists’ preferences for aRCC treatment are determined mainly by the efficacy (survival gain) but also by the HRQoL provided. The results of the study can help to inform decision-making in the selection of appropriate aRCC treatment.

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“…12 Several studies have explored the value that patients, providers, or both place on aspects of benefits and burdens of treatment, including progression-free survival (PFS), landmark overall survival (OS), or toxicities in lung cancer, 13–22 melanoma, 12 , 20 , 23 , 24 and renal cell carcinoma. 25–28 However, no study to date has been designed to elicit how patients and their physicians value a set of attributes with the unique profile of immuno-oncologic treatments, including how patients and physicians trade off increases in mean or median survival versus an increased chance of remission or durable survival or avoiding toxicities associated with cytotoxic chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

<p>The Value of Hope: Patients’ and Physicians’ Preferences for Survival in Advanced Non-Small Cell Lung Cancer</p>

Hauber¹,

Penrod²,

Gebben³

et al. 2020

PPA

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Purpose Immuno-oncology treatments offer patients with advanced non-small cell lung cancer (NSCLC) treatment options with greater probability of durable survival and a different toxicity profile compared with traditional chemotherapy. The objective of this study was to explore the importance of increases in the probability of long-term survival versus changes in expected (median) survival and treatment toxicities among patients with advanced NSCLC and physicians. Patients and Methods In a discrete-choice experiment, oncologists and patients diagnosed with NSCLC chose between profiles of treatments for advanced NSCLC offering different combinations of benefits (expected, best-case, and worst-case survival) and risks. We analyzed preference data from each sample using a random-parameters logit model that controls for preference heterogeneity and the panel nature of the data. Results Both patients and physicians expressed a strong preference for improving the probability of best-case survival; however, patients viewed increases in the probability of long-term survival as more important than increases in expected survival, while the opposite was true for physicians. Both patients and physicians weighted survival to be more important than toxicities. Conclusion This study identified a potentially important divergence between physician and patient perspectives on survival statistics. Physicians placed more importance on increases in expected survival than did patients with NSCLC. The importance patients placed on long-term survival reinforce previous research identifying the primacy of hope as a value among seriously ill patients. The findings underscore the importance of considering patients’ priorities and in shared decision-making when choosing treatment.

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Comparing the Relative Importance of Attributes of Metastatic Renal Cell Carcinoma Treatments to Patients and Physicians in the United States: A Discrete-Choice Experiment

Abstract: Patients and physicians indicated that PL3Y was the most important treatment attribute and was significantly more important than PFS. Importance rankings differed between physicians and patients and between all patients and those with advanced/metastatic disease.

Cited by 17 publications

References 34 publications

Patient and caregiver benefit‐risk preferences for nonmetastatic castration‐resistant prostate cancer treatment

Patient and caregiver benefit‐risk preferences for nonmetastatic castration‐resistant prostate cancer treatment

Preferences for Renal Cell Carcinoma Pharmacological Treatment: A Discrete Choice Experiment in Patients and Oncologists

<p>The Value of Hope: Patients’ and Physicians’ Preferences for Survival in Advanced Non-Small Cell Lung Cancer</p>

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