Cancer Patients Look Beyond Average Results In Value of Treatments

Cancer Patients Look Beyond Average Results In Value of Treatments

04.12.12 | By Greg Lopes

There's nothing more important for a patient than hope - especially for patients faced with a cancer diagnosis. And when faced with a choice between a treatment that offers a shot at longer-term survival vs. a treatment that guarantees a shorter survival gain, cancer patients take the gamble and choose hope.

These findings may not sound surprising. But what is surprising is that our current models for valuing new treatments do a very poor job recognizing this.

In a series of articles in this month's issue of Health Affairs, researchers examine the benefits and costs of cancer care. This new research into cancer care takes a trailblazing look at measuring aspects of care that the health policy world rarely recognizes. Recently, I summarized one the articles that focused on the financial value associated with additional years of survival. Today, I'm looking at another study in the series that aims to measure the value that patients with a limited life expectancy place on the survival outcomes of a therapy. In other words, the researchers are trying to measure the "hope" of a longer period of survival beyond the average survival gain.

In the study, Darius N. Lakdawalla from the University of Southern California and his fellow researchers explain the idea of a "sure bet" therapy versus one that is a "hopeful gamble," with each offering different survival gains. One therapy - referred to as a "sure bet" - promises patients exactly eighteen months of additional survival. An alternative treatment - called a "hopeful gamble" - promises a 50 percent chance of thirty-six months of additional survival but also a 50 percent chance of no additional survival. Statistically speaking, the treatments look equivalent - both offer an average of eighteen months of expected survival gain. But the "hopeful gamble" offers the potential for longer survival, but the risk of no gain in survival. To patients, this means they are anything but equivalent.

The researchers posed the question, "Do patients near the end of life like or dislike therapies with greater spread in survival outcomes?" Through a study of 150 cancer patients looking at hypothetical treatments for melanoma and breast cancer, the researchers found an overwhelming majority of patients chose hope.

According to their findings, 77 percent of the patients surveyed "preferred a hopeful gamble to the sure bet, even though the two provided the same survival, on average. Of the patients in the melanoma arm, 71 percent would give up the chance of living two years for sure in return for a 20 percent chance of living for at least four and a half years. Of the patients in the breast cancer arm, 83 percent would give up the chance of living one and a half years for sure to have a 10 percent chance of living four years or more."

As the authors note, these findings have big implications for the process policy-makers use to evaluate new treatments, called health technology assessment. "Our research suggests that there may be a need to broaden the horizons of health technology assessment when it comes to measuring health gains." They also note that "this analysis points to the larger ideal - that value should be defined from the viewpoint of the patient."

We could not agree more. The value of hope to patients cannot be underestimated when assessing the value of a new test or treatment.

Follow Greg on Twitter @GregAtPhRMA

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