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

Previous research indicates that patients value therapies that provide durable or tail-of-the-curve survival gains, but it is unclear whether physicians share these preferences. To compare patient and physician preferences for treatments with a positive probability of durable survival gains relative...

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Vydané v:Value in health Ročník 20; číslo 2; s. 217 - 223
Hlavní autori: Shafrin, Jason, Schwartz, Taylor T., Okoro, Tony, Romley, John A.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States Elsevier Inc 01.02.2017
Elsevier Science Ltd
Predmet:
Adult
Advanced stage
Apathy
Cancer
Clinical outcomes
Female
Humans
Internal Medicine
Lung cancer
Lung Neoplasms - therapy
Male
Medical treatment
Melanoma
Melanoma - therapy
Middle Aged
Oncologists
Patient Preference
Patients
Physicians
Physicians - psychology
Practitioner patient relationship
preferences
Profiles
Respondents
Skin melanoma
Surveys and Questionnaires
Survival
Tails
Therapy
Treatment methods
Treatment preferences
Valuation
value framework
Value-Based Purchasing
preferences
cancer
value framework
survival
ISSN:1098-3015, 1524-4733, 1524-4733
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Shrnutí:Previous research indicates that patients value therapies that provide durable or tail-of-the-curve survival gains, but it is unclear whether physicians share these preferences. To compare patient and physician preferences for treatments with a positive probability of durable survival gains relative to those with fixed survival gains. Patients with advanced stage melanoma or lung cancer and the oncologists who treated these patients were surveyed. The primary end point was the share of respondents who selected a therapy with a variable survival profile, with some patients experiencing long-term durable survival and others experiencing much shorter survival, compared to a therapy with a fixed survival duration. Parameter estimation by sequential testing was applied to calculate the length of nonvarying survival that would make respondents indifferent between that survival and therapy with durable survival. The sample comprised 165 patients (lung = 84, melanoma = 81) and 98 physicians. For lung cancer, 65.5% of patients preferred the therapy with a variable survival profile, compared with 40.8% of physicians (Δ = 24.7%; P < 0.001). For melanoma, these figures were 63.0% for patients and 29.7% for physicians (Δ = 33.3%; P < 0.001). Patients’ indifference point implied that therapies with a variable survival profile are preferred unless the treatment with fixed survival had 13.6 months (melanoma) or 11.6 months (lung) longer mean survival; physicians would prescribe treatments with a fixed survival if the treatment had 7.5 months (melanoma) or 1.0 month (lung) shorter survival than the variable survival profile. 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.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1098-3015
1524-4733
1524-4733
DOI:10.1016/j.jval.2016.11.028