title: A willingness-to-pay study of oral epidermal growth factor tyrosine kinase inhibitors in advanced non-small cell lung cancer.
abstract: OBJECTIVE
  Oral epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) are new agents in the treatment of advanced non-small cell lung cancer (NSCLC). Phase II studies demonstrate objective tumor responses and symptom improvement, combined with minimal toxicity and the convenience of an oral agent. We evaluated patient utility through willingness-to-pay (WTP) for these agents in the treatment of advanced NSCLC in Canada.
  
  
  METHODS
  Advanced NSCLC patients and healthy subjects participated in a structured interview and bidding exercise, reviewing current evidence supporting EGFR TKI therapy in advanced NSCLC and patient willingness-to-pay for treatment.
  
  
  RESULTS
  Fifty-seven patients and 54 healthy subjects participated. The median amount both groups were willing to pay for a month of oral EGFR TKI therapy was $100 CAD (range $0-5000 per month). A minority of NSCLC patients received employment income, the majority relying on disability, pension income, and social assistance for financial support. Affordability of these agents was a key concern for both advanced NSCLC patients and healthy subjects. Univariate predictors of WTP included marital status, prior chemotherapy treatment, receiving pension income or financial social assistance. In multivariate analysis, only prior chemotherapy remained a significant predictor of WTP (p=0.049).
  
  
  CONCLUSIONS
  Both advanced NSCLC patients and healthy subjects feel oral EGFR TKIs are worth paying for in the treatment of advanced NSCLC, but are willing to pay only a fraction of the market price. As many advanced NSCLC patients are financially disadvantaged, the potential for restricted access to newer therapies is of concern.
authors.affiliation: Department of Medicine, Faculty of Medicine, Princess Margaret Hospital/University Health Network, University of Toronto, 5-222 610 University Avenue, Toronto, Ont., Canada M5G 2M9. Natasha.Leighl@uhn.on.ca
authors.forename: Natasha B
authors.initials: NB
authors.lastname: Leighl
authors.forename: W Stephen
authors.initials: WS
authors.lastname: Tsao
authors.forename: Dianne L
authors.initials: DL
authors.lastname: Zawisza
authors.forename: Mahsan
authors.initials: M
authors.lastname: Nematollahi
authors.forename: Frances A
authors.initials: FA
authors.lastname: Shepherd
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D017281:Cost of Illness; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D000069347:Erlotinib Hydrochloride; D005252:Fees, Pharmaceutical; D005260:Female; D005500:Follow-Up Studies; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010349:Patient Compliance; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage* / Q000191:economics; D011799:Quinazolines / Q000008:administration & dosage / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors; D000077156:Gefitinib