PCN203 Valuing Hope with Cancer Treatments Independent of Survival Gains

Abstract

To quantify value of hope as a construct for potential use in value assessment frameworks. We designed a discrete-choice experiment in which pairs of treatment alternatives were constructed using probabilities of achieving long-term (i.e. 10-year) survival (0%, 5%,10%, and 20%) and the corresponding probabilities and durations of short-term survival such that expected survival for the alternative equaled 2, 3, or 5 years. Other attributes were health status and out-of-pocket cost, representing 0%, 10%, 30% or 80% of participants’ reported annual income. Each participant was randomly assigned to one of 12 blocks of 10 choice questions. Following a pilot study in 120 adults, 200 patients with cancer or history of cancer were recruited by Cancer Support Community. We computed dollar-equivalent values for treatments offering 5%, 10% and 20% chances of long-term survival versus a 0% chance of long-term survival (i.e. guaranteed 2-, 3- or 5-year survival). We evaluated preference heterogeneity using mixed-logit and latent-class models. Participants’ choices implied that they preferred a 5% versus a 0% chance of long-term survival (p=0.054) and a 10% versus a 0% chance of long-term survival (p=0.001) when holding expected survival constant. However, participants did not indicate a preference for treatments offering a 20% versus a 0% chance of long-term survival (p=0.38) due to the offsetting 80% chance of shorter survival to maintain the same duration of expected survival. Compared to a 0% chance, dollar-equivalent values were $5,975 (95%CI: -145 to 12,629) for a 5% chance and $12,421 (95%CI: 5,082 to 20,744) for a 10% chance of long-term survival, independent of health status or expected survival. Latent-class analysis revealed 4 groups with distinct preference patterns. Independent of expected survival and health status, patient preferences are consistent with positive value for hope. However, this finding does not universally hold in all situations nor across individuals.