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

Abstract

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, immunotherapyrelated 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

Development and validation of a web-based patient decision aid for immunotherapy for patients with metastatic melanoma: study protocol for a multicenter randomized trial

“…Hence, the risks and benefits vary considerably between the possible treatment options [ 10 , 11 ]. In a recent study on treatment choices, melanoma patients (stages I–IV) and their providers systematically accepted all levels of risk for adverse events in exchange for improved survival rates [ 12 ]. This finding suggests that patients make extreme, yet conscious, decisions.…”

“…Targeted therapy has a higher response rate but does not offer a long-term benefit comparable to that of checkpoint inhibitors, due to the mechanisms of resistance. As the overall survival rate is the strongest determinant of the treatment decision, patients with melanoma (stages I–IV) and their providers systematically prefer combination immunotherapy over targeted therapy [ 12 ]. However, in some clinical situations, e.g., in symptomatic patients, the need for tumor reduction might lead to a recommendation of BRAF/MEK inhibition therapy.…”

“…For physicians, it is very challenging to involve patients according to their need for information and participation, as medical facts are very complex and not easy to communicate. In addition, physicians sometimes misinterpret the views of melanoma patients on decision determinants such as quality of life, fear, and trust in medical opinion [ 12 ].…”

Patient preferences for treatment of advanced melanoma: impact of comorbidities

“…A DCE by Stenehjem and colleagues revealed that melanoma patients and care providers had the highest preference for OS and avoidance of immunotherapy‐related AE, even though the perceptions about quality of life expectations and PFS differed [26]. Both patients and care providers reported higher WTP for ipilimumab plus nivolumab than for BRAF/MEK inhibitors [26]. According to a DCE by Mansfield et al., melanoma patients were willing to trade an increased risk of AE for prolonged PFS [27].…”

“…We recently conducted a DCE on preferences for key attributes of modern systemic melanoma treatments of patients with advanced melanoma (AJCC stage IIC–IV) from five German skin cancer clinics [29]. Concordant with the industry‐sponsored studies mentioned above [24–27], our participants had highest preferences for efficacy, followed by safety, but preferences varied significantly depending on age, marital status, education and treatment experience [29].…”