What is the Value of Hope in Cancer Care? from HealthWorks Collective

We have all heard about cancer treatments that cost $100,000 or more, but only yield an average survival of a couple of months.  Is it worth it, you may have wondered, especially when there are so many other healthcare treatments that produce longer survivals and, perhaps, better quality of life?

The answer, of course, depends on who you are.  If you are the young, healthy Chief Medical Officer of a Health Plan, responsible for making decisions about how precious resources are spent, you may not value a very expensive cancer treatment with a short median survival time as highly as a less expensive treatment for another disease that has more impressive survival statistics.  However, if you are a young mother with metastatic breast cancer, it is likely that the value calculation is quite different.

If you now factor in the difference between the average survival and the spread of survival related to any given treatment, the calculation changes yet again.  As a patient with an advanced cancer, you may not want to spend $100,000 on a treatment if you knew for sure that your survival was only going to be three months, but what if there was a 15% chance that the same treatment could give you an additional twenty months of life?

In an effort to shed light on this issue, Darius Lakdawalla (Director of Research at the Leonard D. Schaeffer Center for Health Policy and Economics, USC) and colleagues designed an interesting study that was published in the April 2012 issue of Health Affairs.  The empirical question was “Do patients near the end of life like or dislike therapies with greater spread in survival outcomes?”  In other words, “would patients value the ‘hope’ of a large survival gain, independent of a therapy’s average gain.”

Darius Lakdawalla, Dir. Research, USC

To answer the question, the researchers presented different scenarios to cancer patients and asked them to choose which treatment they preferred and how much they would be willing to pay for it.  There were two scenarios, one that described options for treatment of metastatic breast cancer and the other treatment for advanced melanoma.  The treatments presented to the patients were “real-world” therapies based on the published clinical trials.

The metastatic breast cancer treatment “hopeful” scenario was based on a recent clinical trial in which combination therapy, ixabepilone (Ixempra) plus capecitabine (Xeloda), produced a median survival of 12.9 months, but a one in ten chance of living past forty-eight months.  It was compared to a hypothetical treatment that they were told would produce, with 100% certainty, an eighteen month survival – a “sure bet.”

for more, http://healthworkscollective.com/psalber/31660/what-value-hope-cancer-care?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+healthworkscollective_allposts+%28Healthworks+Collective%29