A multinational study to measure the value that patients with cancer place on improved emesis control following cisplatin chemotherapy.
BACKGROUND
The neurokinin-1 (NK1) receptor antagonists are a new class of agents designed to reduce the risk of emesis following chemotherapy, particularly with cisplatin. Early data from double-blind randomised trials suggest that an orally administered NK1 antagonist can reduce the absolute risk of acute and delayed emesis following cisplatin by 20 and 30%, respectively.


OBJECTIVE
To measure the value that patients with cancer place on improved emesis control and quality of life.


METHODS
Willingness-to-pay analysis.


METHODS
Five study sites in Canada, Italy, Spain and Greece.


METHODS
245 patients with cancer either receiving chemotherapy with cisplatin or who had received cisplatin-based chemotherapy within the previous 6 months.


METHODS
After background information had been presented, patients were asked to define the maximum that they would pay per day for a drug that reduced their risk of acute and delayed (days 2 to 5) emesis by 20 and 30%, respectively. Costs were converted to US dollars ($US) using year 2000 exchange rates.


RESULTS
For a 20% improvement in acute emesis, Canadian, Italian and Spanish patients with cancer were willing to pay $US46, $US34 and $US63 per day, respectively, compared with $US8 for patients from Greece (p < 0.001). For a 30% improvement in delayed emesis, Canadian, Italian and Spanish patients with cancer were also willing to pay more than their Greek counterparts (SUS41, $US31, $US50 and $US9 daily for 4 days, respectively; p < 0.001). These significant differences in patient value between countries remained, even after adjusting for socioeconomic variables and previous history of emesis.


CONCLUSIONS
There are substantial cultural differences in how patients with cancer value benefit and improved quality of life. Since the majority of the world's population resides outside North America and Western Europe, there may be a need to re-evaluate perceived levels of patient benefit and measures of quality of life.
Dranitsaris
G
G
Department of Pharmaceutical Services, University Health Network/Princess Margaret Hospital, Toronto, Ontario, Canada. gdranit@istar.ca
Leung
P
P
Ciotti
R
R
Ortega
A
A
Spinthouri
M
M
Liaropoulos
L
L
Labianca
R
R
Quadri
A
A
D000932:Antiemetics / Q000191:economics* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001294:Attitude to Health; D002170:Canada; D002945:Cisplatin / Q000009:adverse effects* / Q000627:therapeutic use; D005060:Europe; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D011788:Quality of Life; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
D000932:Antiemetics; D000970:Antineoplastic Agents; D002945:Cisplatin