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Immunotargeted therapy in melanoma

patient, provider preferences, and willingness to pay at an academic cancer center

Stenehjem, David D.a,d; Au, Trang H.a,c; Ngorsuraches, Surachate; Ma, Junjiea; Bauer, Hillevia; Wanishayakorn, Tanatapea; Nelson, Ryan S.a; Pfeiffer, Constance M.f; Schwartz, Joshuaf; Korytowsky, Beataf; Oderda, Garya; Brixner, Diana I.a,b

doi: 10.1097/CMR.0000000000000572
Original article: PDF Only

Objective New melanoma therapies have shifted the expectations of patients and providers. Evaluating the impact of treatment characteristics may enhance shared decision making.

Patients and methods A survey, including a discrete choice experiment, was utilized to evaluate perceived trade-offs of different melanoma treatments and to estimate out-of-pocket (OOP) willingness-to-pay (WTP) thresholds (January 2016 to March 2016). Participants included patients with melanoma at Huntsman Cancer Institute and their cancer care providers. Stakeholder focus groups were conducted to identify treatment attributes. Descriptive and comparative statistics and multinomial logit model were used to evaluate responses.

Results Response rates were 41.9% (N=220) for patients and 37.7% (N=20) for providers. Immunotherapy and targeted therapy attributes considered important by participants were overall survival, immunotherapy-related side effects, and skin toxicities. Patients and providers had significantly different views of quality-of-life expectations, anxiety toward melanoma, trust to make treatment decisions, sharing concerns about treatment, time to discuss treatment, understanding OOP costs, and willingness to undergo/recommend treatment (half of the patients would undergo treatment if it was effective for >24 months). Among patients, the average monthly OOP WTP for combination immunotherapy with nivolumab+ipilimumab was $2357 and for BRAF/MEK inhibitor was $1648. Among providers, these estimates were $2484 and $1350, respectively.

Conclusion Discordance existed between patients’ and providers’ perceptions about quality of life expectations, degree of anxiety, sharing of opinions, and progression-free survival. Our study suggests that patients and providers exhibit a higher OOP WTP for combination immunotherapy treatment compared with BRAF/MEK inhibitors, influenced predominately by overall survival expectations.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

aDepartment of Pharmacotherapy, College of Pharmacy

bProgram in Personalized Healthcare, University of Utah

cHuntsman Cancer Institute, Salt Lake City, Utah

dDepartment of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, Minnesota

eHarrison School of Pharmacy, Auburn University, Auburn, Alabama

fBristol-Myers Squibb, Princeton, New Jersey, USA

Correspondence to Diana I. Brixner, RPh, Department of Pharmacotherapy, Executive Director Outcomes Research Center, College of Pharmacy, Director of Outcomes, Program in Personalized Healthcare, University of Utah, Utah 84112, USA Tel: +1 801 581 3182; fax: +1 801 587 7923; e-mail:

Received June 26, 2018

Accepted December 19, 2018

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