Does the Public Prefer Health Gain for Cancer Patients? A Systematic Review of Public Views on Cancer and its Characteristics

Abstract

BackgroundPolicies such as the Cancer Drugs Fund in England assumed a societal preference to fund cancer care relative to other conditions, even if that resulted in lower health gain for the population overall.ObjectiveThe aim of this study was to investigate the evidence for such a preference among the UK public.MethodsThe MEDLINE, PubMed and Econlit electronic databases were searched for studies relating to preferences for prioritising cancer treatment, as well as studies relating to preferences for the characteristics of cancer (severity of disease, end-of-life). The searches were run in November 2015 and updated in March 2017. Empirical preference studies, studies of public views, and studies in English were included.ResultsWe identified 24 studies relating to cancer preferences. Two directly addressed health trade-offs in the UK—one showed a preference for health gain in cancer, while the other found no such preference but provided results consistent with population health maximisation. Other studies mostly showed support for cancer but did not require a direct health trade-off. Severity and end-of-life searches identified 12 and 6 papers, respectively, which were additional to existing reviews. There is consistent evidence that people give priority to severe illness, while results for end-of-life are mixed.ConclusionWe did not find consistent support for a preference for health gains to cancer patients in the context of health maximisation. The evidence base is small and the results are highly sensitive to study design. There remains a contradiction between these findings and the popular view of cancer, and further work is required to determine the features of cancer which contribute to that view.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-017-0511-7) contains supplementary material, which is available to authorized users.

Dread and Risk Elimination Premium for the Value of a Statistical Life

“…() found no significant impact of the morbidity period. Reviews of the cancer premium literature suggest that the current level of evidence is insufficient to determine whether the WTP is higher in the context of cancer (Lindhjelm et al., ; Morrell, Wordsworth, Rees, & Barker, ; Shah, ).…”

“…Although McDonald et al (2016) found that the premium is primarily driven by the duration of morbidity, van Houtven et al (2008) found no significant impact of the morbidity period. Reviews of the cancer premium literature suggest that the current level of evidence is insufficient to determine whether the WTP is higher in the context of cancer (Lindhjelm et al, 2011;Morrell, Wordsworth, Rees, & Barker, 2017;Shah, 2017).…”

Cancer as the “perfect storm”? A qualitative study of public attitudes to health conditions

“…9 However, in a recent literature review, we found that when studies ask people to trade off funding cancer care against equivalent health improvement for other conditions, they do not consistently show a preference for cancer funding. 10 For example, a large-scale choice study that addresses this question directly for the UK found no support for prioritizing cancer above other conditions all else being equal but a preference for obtaining greater health improvement overall. 11 Other prioritizing factors have been evaluated in similar trade-off studies.…”

“…11 Other prioritizing factors have been evaluated in similar trade-off studies. There is a body of evidence supporting prioritizing of severe disease, although the definitions of severity vary 10,12,13 ; severity is not explicitly prioritized in the UK, although National Institute for Health and Clinical Excellence (which makes funding recommendations for England's National Health Service) can give special consideration to severe disease. 14 Short life expectancy and rarity are given funding priority in the UK, through policies such as National Institute for Health and Clinical Excellence's end-of-life criteria, 15 Highly Specialised Technologies appraisal proces, 16 and the Scottish Medicines Consortium (SMC)'s end-of-life, orphan, and ultra-orphan processes 17 ; the evidence on preference is mixed 10,11,13,18 with an important UK study showing no preference for either.…”

“…There is a body of evidence supporting prioritizing of severe disease, although the definitions of severity vary 10,12,13 ; severity is not explicitly prioritized in the UK, although National Institute for Health and Clinical Excellence (which makes funding recommendations for England's National Health Service) can give special consideration to severe disease. 14 Short life expectancy and rarity are given funding priority in the UK, through policies such as National Institute for Health and Clinical Excellence's end-of-life criteria, 15 Highly Specialised Technologies appraisal proces, 16 and the Scottish Medicines Consortium (SMC)'s end-of-life, orphan, and ultra-orphan processes 17 ; the evidence on preference is mixed 10,11,13,18 with an important UK study showing no preference for either. 11 However, encouraging orphan drug development is consistent with an egalitarian preference (providing "something for everybody") seen in some studies, 19,20 and both short life expectancy and the rare metabolic disease of childhood seen by the Highly Specialised Technologies process would likely be considered "severe" by most observers.…”