Patient Versus Physician Valuation of Durable Survival Gains: Implications for Value Framework Assessments

Shafrin, Jason; Schwartz, Taylor; Okoro, Tony; Romley, John A.

doi:10.1016/j.jval.2016.11.028

Cited by 36 publications

(58 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Technologies that provide an opportunity for a cure would thus be more valuable to many patients, and a payer, acting as their agent, would be willing to pay more on their behalf. Empirical work relying on discrete choice experiments provides support for this element and demonstrates how to value it [31,33].…”

Section: Value Of Hopementioning

confidence: 99%

Defining Elements of Value in Health Care—A Health Economics Approach: An ISPOR Special Task Force Report [3]

et al. 2018

View full text Add to dashboard Cite

The third section of our Special Task Force report identifies and defines a series of elements that warrant consideration in value assessments of medical technologies. We aim to broaden the view of what constitutes value in health care and to spur new research on incorporating additional elements of value into cost-effectiveness analysis (CEA). Twelve potential elements of value are considered. Four of them-quality-adjusted life-years, net costs, productivity, and adherence-improving factors-are conventionally included or considered in value assessments. Eight others, which would be more novel in economic assessments, are defined and discussed: reduction in uncertainty, fear of contagion, insurance value, severity of disease, value of hope, real option value, equity, and scientific spillovers. Most of these are theoretically well understood and available for inclusion in value assessments. The two exceptions are equity and scientific spillover effects, which require more theoretical development and consensus. A number of regulatory authorities around the globe have shown interest in some of these novel elements. Augmenting CEA to consider these additional elements would result in a more comprehensive CEA in line with the "impact inventory" of the Second Panel on Cost-Effectiveness in Health and Medicine. Possible approaches for valuation and inclusion of these elements include integrating them as part of a net monetary benefit calculation, including elements as attributes in health state descriptions, or using them as criteria in a multicriteria decision analysis. Further research is needed on how best to measure and include them in decision making.

show abstract

Section: Value Of Hopementioning

confidence: 99%

Defining Elements of Value in Health Care—A Health Economics Approach: An ISPOR Special Task Force Report [3]

et al. 2018

View full text Add to dashboard Cite

show abstract

“…A minority of oncologists, on the other hand, would select the therapy with a chance of durable survival for patients with melanoma (29.7%) or lung cancer (40.8%). 20 Although the hypothetical treatment profiles evaluated in these studies and in our study differed, the results reveal consistently divergent priorities between patients and physicians.…”

Section: Discussionmentioning

confidence: 53%

“…12 This phenomenon has been termed the value of hope. 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

View full text Add to dashboard Cite

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.

show abstract

“…In one-way sensitivity analysis (Figure 3), we found that the utility values of PFS are the most significant parameter that could change the ICER value. Generally, utility is influenced by the social and cultural values of the stakeholders, and therefore it might differ across countries 36–38. However, in the present study, the utilities were not directly obtained from the LUX-lung 6 trial or a Chinese population.…”

Section: Discussionmentioning

confidence: 95%

“…We assumed patients from both treatment groups received docetaxel after disease progression, which may not always mimic the treatment in the real world because patients might switch to subsequent therapy upon the further progressions, for example the use of platinum-based combination chemotherapy is also possible after the failure of EGFR inhibitors. Fourth, our value frameworks rely on efficacy measures based on improvements in survival rate of median patients, and hence did not take into account of the improvements in “tail of the curve survival”, which may impact the current treatment decisions 38. Finally, we have identified for healthcare policymakers in China whether afatinib strategy is of the best value for money.…”

Section: Discussionmentioning

confidence: 99%

<p>Cost-Effectiveness Analysis Of EGFR Mutation Testing And Afatinib Versus Gemcitabine-Cisplatin As First-Line Therapy For Advanced Non-Small-Cell Lung Cancer In China</p>

You

Liu

et al. 2019

CMAR

View full text Add to dashboard Cite

ObjectiveThe purpose of this study was to evaluate the cost-effectiveness of the combined use of afatinib and epidermal growth factor receptor (EGFR) testing versus gemcitabine-cisplatin as the first-line treatment for patients with non-small cell lung cancer (NSCLC) in China.MethodsA decision-analytic model, based on clinical phase III trials, was developed to simulate patient transitions. Direct costs were estimated from the perspective of the Chinese healthcare system. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) were calculated over a 5-year lifetime horizon. Model robustness was conducted in sensitivity analyses.ResultsFor the base case, EGFR mutation testing followed by afatinib treatment for advanced NSCLC increased 0.15 QALYs compared with standard chemotherapy at an additional cost of $5069.12. The ICER for afatinib maintenance was $33,416.39 per QALY gained. The utility of PFS and the cost of afatinib had the most important impact on the ICER. Scenario analyses suggested that when a patient assistance program (PAP) was available, ICER decreased to $22,972.52/QALY lower than the willingness-to-pay (WTP) threshold of China ($26,508/QALY).ConclusionOur results suggest that gene-guided maintenance therapy with afatinib with the PAP might be a cost-effective treatment option compared with gemcitabine – cisplatin in China.

show abstract

Patient Versus Physician Valuation of Durable Survival Gains: Implications for Value Framework Assessments

Abstract: Patients place a high value on therapies that provide a chance of durable or "tail-of-the-curve" survival, whereas physicians do not. Value frameworks should incorporate measures of tail-of-the-curve survival gains into their methodologies.

Cited by 36 publications

References 31 publications

Defining Elements of Value in Health Care—A Health Economics Approach: An ISPOR Special Task Force Report [3]

Defining Elements of Value in Health Care—A Health Economics Approach: An ISPOR Special Task Force Report [3]

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

<p>Cost-Effectiveness Analysis Of EGFR Mutation Testing And Afatinib Versus Gemcitabine-Cisplatin As First-Line Therapy For Advanced Non-Small-Cell Lung Cancer In China</p>

Contact Info

Product

Resources

About