title: How long and how well: oncologists' attitudes toward the relative value of life-prolonging v. quality of life-enhancing treatments.
abstract: To determine how oncologists value quality-enhancing v. life-prolonging outcomes attributable to chemotherapy.
  
  
  
  The authors surveyed a random sample of 1379 US medical oncologists (members of the American Society of Clinical Oncology), presenting them with 2 scenarios involving a hypothetical new chemotherapy drug. Given their responses, the authors derived the implicit cost-effectiveness ratios each physician attributed to quality-enhancing and life-prolonging chemotherapies.
  
  
  
  The authors received responses from 58% of the oncologists surveyed. On average, the responses implied that oncologists were willing to prescribe treatments that cost $245,972 per quality-adjusted life-year (QALY; SD $243,663 per QALY) in life-prolonging situations v. only $119,082 per QALY (SD $197,048 per QALY) for treatments that improve quality of life but do not prolong survival (P < 0.001). This difference did not depend on age, gender, percentage of time in clinical work, or self-reported preparedness to use and interpret cost-effectiveness information (P > 0.05 for all specifications). Differences across these situations persisted even among those who considered themselves to be "well-prepared" to make cost-effectiveness decisions.
  
  
  
  Cost-effectiveness thresholds for oncologists vary widely for life-prolonging chemotherapy compared to treatments that only enhance quality of life. This difference suggests that oncologists value length of survival more highly than quality of life when making chemotherapy decisions.
authors.affiliation: Center for Behavioral and Decision Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI (MAK, AJ, PAU)
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kozminski
authors.affiliation: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA (PJN)
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Neumann
authors.affiliation: Charles Sammons Cancer Center, Baylor University Medical Center, Dallas, TX (ESN)
authors.forename: Eric S
authors.initials: ES
authors.lastname: Nadler
authors.affiliation: Center for Behavioral and Decision Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI (MAK, AJ, PAU)
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Jankovic
authors.affiliation: Center for Behavioral and Decision Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI (MAK, AJ, PAU)|Ann Arbor Veterans Affairs Medical Center, the Division of General Internal Medicine, Ann Arbor, MI (PAU)
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
mesh_terms: D001291:Attitude of Health Personnel; D003362:Cost-Benefit Analysis; D003625:Data Collection; D003657:Decision Making; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D014481:United States; D026712:Value of Life / Q000191:economics*