PCN126 - which is more valuable, longer survival or better quality of life? Israeli oncologists' and family physicians' attitudes toward the relative value of new cancer and gongestive heart failure interventions

Abstract

Willingness to pay (WTP) for new health technologies may vary between interventions that prolong patients' life-expectancy and interventions that only improve patients' quality of life (QoL), and among different types of disease. We determined how Israeli oncologists and family physicians value life-prolongation vs. QoL-enhancing outcomes attributable to cancer and congestive heart failure (CHF) interventions. We presented physicians with two scenarios involving a hypothetical patient with metastatic cancer expected to survive 12-months with current treatment. In a life-prolongation scenario, we suggested that a new treatment increases survival at an incremental cost of $50,000 over the standard of care. Participants were asked what minimum improvement in median months of survival the new therapy would need to provide for them to recommend it over standard of care. In the QoL-enhancing scenario, we asked the maximum WTP for an intervention that leads to the same survival as the standard treatment, but increases patient's QoL from 50 to 75 (on a 0-100 scale). We replicated these scenarios substituting a patient with CHF NYHA Class IV instead of metastatic cancer. We derived the incremental cost-effectiveness ratio (ICER) per QALY gained threshold implied by each response. In the life-prolongation scenario the median cost-effectiveness thresholds implied by oncologists were $150,000/QALY and $100,000/QALY for cancer and CHF respectively. Median cost-effectiveness thresholds implied by family physicians were $50,000/QALY regardless the disease type. WTP for the QoL-enhancing scenarios was $60,000/QALY and did not differ by physicians' specialty or disease type. Our findings suggest that family physicians value life-prolonging and QoL-enhancing interventions roughly equally, while oncologists value interventions that extend survival more highly than those that only improve QoL. These findings may have important implications for coverage and reimbursement decisions of new technologies.