PCN265 BREAST CANCER PATIENT PREFERENCE AND WILLINGNESS TO PAY FOR GRANULOCYTE COLONY-STIMULATING FACTORS (G-CSF)

Abstract

Short- and long-acting G-CSFs are indicated to decrease the incidence of infection as manifested by febrile neutropenia (FN), a severe side effect of myelosuppressive chemotherapy. Objective to estimate breast cancer patients' relative preferences and willingness to pay (WTP) for different G-CSF prophylaxis attributes. We completed a discrete choice experiment via an online cross-sectional survey of self-reported breast cancer patients previously treated with myelosuppressive chemotherapy. Participants were presented 18 G-CSF scenarios with different levels of the following attributes: risk of developing FN requiring hospitalization, risk of disrupting the chemotherapy schedule due to FN, need for additional clinic visits, number of G-CSF administrations, and total out-of-pocket (OOP) G-CSF cost per chemotherapy cycle. Attribute preferences and WTP were measured using hierarchical Bayesian logistic regression. By descending median preference weight, participants (N=302) preferred G-CSF options with the lowest OOP cost (difference between highest and lowest=2.682; 95% CI=2.177–3.311), lowest risk of FN requiring hospitalization (1%:24%; difference=2.352; 95% CI=1.900–2.750), lowest risk of chemotherapy disruption (low:high; difference=1.436; 95% CI=1.162–1.718), lower number of clinic visits (0:11; difference=1.302, 95% CI=0.944–1.648), and fewer administrations (1:11; difference=0.770; 95% CI=0.541–1.008). Median incremental WTP was $948 to reduce the risk of FN requiring hospitalization (1%:24%), $469 to reduce the risk of disrupting chemotherapy (low:high), $420 to reduce the number of additional clinic visits (0:11), and $205 to reduce the number of G-CSF administrations (1:11). Several distinct subgroups (eg, those from the Midwest, on Medicare Part D, and with on-body-injector experience) valued the convenience of reducing clinic visits more than others. G-CSF options that provide improvements in clinical outcomes (ie, reduced risk of FN and chemotherapy disruption) and greater convenience (ie, fewer visits, fewer administrations) were preferred and had higher WTP. When making treatment decisions, physicians should consider G-CSF options that provide convenience in addition to improved clinical outcomes.