Abstract
Malignant melanoma is potentially life-threatening but in most cases curable if detected early. Willingness to pay (WTP) is a preference-based construct that reflects burden of disease by assessment of the monetary value for a hypothetical cure from disease. Since WTP (directly as total amount of money) has not been assessed so far in patients with low risk melanoma, it was interesting to gain insights in this patient population and then, in a second step, compare it directly with the WTP of their treating dermato-oncologists. WTP was assessed in 125 patients with low-risk melanoma and additionally in 105 treating physicians, asking for the one-time and continuous payments they would be willing to make for a sustainable cure, both as absolute sums and as percentages of monthly income. The median WTP based on one-time payment was €10,000 for patients and €100,000 for physicians; relative numbers were 100% versus 300% of monthly income. For continuous monthly payments, WTP was €500 for patients and €1000 for physicians, relative numbers 25% and 50% of income, respectively. Even after controlling for income differences, there was a significantly higher WTP in physicians for all four questions. Compared to patients with chronic skin diseases such as vitiligo, rosacea, atopic eczema and psoriasis, patients with low-risk melanoma showed a significantly higher WTP. Our data suggest that there is a relevant burden of disease even in patients with low-risk tumors. Higher WTP of physicians underlines the prevalence of differences in disease perception.
Highlights
The incidence of cutaneous malignant melanoma has been increasing steadily for the last 50 years in fair-skinned populations and is one of the fastest growing cancer entities [1]
The approval of new drugs such as immune checkpoint inhibitors and targeted therapies markedly improved overall survival [6]. This treatment benefit is associated with immune-related adverse events including colitis, hypophysitis and hepatitis potentially impairing Quality of life (QoL) and with the need of a specific side effect management [7]
The missing values for the absolute amounts of money (35.0% for one-time payment and 31.8% for continuous payment) were higher than for payment expressed as a percentage of income (24.1% for one-time payment and 26.8% for continuous payment)
Summary
The incidence of cutaneous malignant melanoma has been increasing steadily for the last 50 years in fair-skinned populations and is one of the fastest growing cancer entities [1]. The approval of new drugs such as immune checkpoint inhibitors and targeted therapies markedly improved overall survival [6] This treatment benefit is associated with immune-related adverse events (irAEs) including colitis, hypophysitis and hepatitis potentially impairing QoL and with the need of a specific side effect management [7]. A study performed in the US, which included 150 cancer patients, showed that 25% of melanoma patients were willing to pay at least €32,865 ($45,000) choosing a therapy with a chance of a longer survival, but possibly not resulting in an improvement of QoL at all. A study in German patients measured WTP and preference of quality versus length of life in small samples of melanoma patients, physicians and healthy controls. Attitudes and variables that influence the patients’ preferences were analyzed
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