title: Discrete choice experiment to estimate breast cancer patients' preferences and willingness to pay for prophylactic granulocyte colony-stimulating factors.
abstract: OBJECTIVE
  Rising out-of-pocket costs for cancer patients have increased shared decision making. Clinical guidelines recommend prophylactic granulocyte colony-stimulating factor (G-CSF) for patients receiving chemotherapy with a 20% or greater risk of febrile neutropenia. A discrete choice experiment was conducted to explore breast cancer patients' preferences and willingness to pay (WTP) for prophylactic G-CSF to decrease the risk of chemotherapy-induced febrile neutropenia.
  
  
  METHODS
  An online discrete choice experiment questionnaire survey of a national US convenience sample of self-reported breast cancer patients with prior chemotherapy treatment was conducted. Sixteen paired G-CSF treatment scenarios, each with four attributes (risk of disruption to chemotherapy schedule due to low white blood cell counts, risk of developing an infection requiring hospitalization, frequency of administration, and total out-of-pocket cost) were presented with a follow-up "no treatment" option. Participant preferences and WTP out of pocket were estimated by logistic regression.
  
  
  RESULTS
  Participants (n = 296) preferred G-CSF regimens with lower out-of-pocket costs, lower risk of chemotherapy disruption, lower risk of infection, and greater convenience (one G-CSF injection per chemotherapy cycle). Participants' WTP was $1076 out of pocket per cycle to reduce the risk (high to low) of disrupting their chemotherapy schedule, $884 per cycle to reduce the risk (24% [high] to 7% [low]) of infection, and $851 per cycle to decrease the number of G-CSF injections (11 to 1) per cycle.
  
  
  CONCLUSIONS
  Participants highly valued specific features of prophylactic G-CSF treatment including maintaining their chemotherapy schedule, lowering their risk of infection, and reducing the number of injections. Physicians should consider patient preferences to inform the best treatment choices for individual patients.
authors: OptumInsight, Eden Prairie, MN, USA. Electronic address: phaedra.johnson@optum.com.
authors: Phaedra
authors: P
authors: Johnson
authors: OptumInsight, Eden Prairie, MN, USA.
authors: Tim
authors: T
authors: Bancroft
authors: Amgen, Inc., Thousand Oaks, CA, USA.
authors: Richard
authors: R
authors: Barron
authors: Amgen, Inc., Thousand Oaks, CA, USA.
authors: Jason
authors: J
authors: Legg
authors: Amgen, Inc., Thousand Oaks, CA, USA.
authors: Xiaoyan
authors: X
authors: Li
authors: Amgen, Inc., Thousand Oaks, CA, USA.
authors: Holly
authors: H
authors: Watson
authors: University of California, Los Angeles, CA, USA.
authors: Arash
authors: A
authors: Naeim
authors: OptumInsight, Eden Prairie, MN, USA.
authors: Angela
authors: A
authors: Watkins
authors: University of Calgary, Calgary, AB, Canada.
authors: Deborah A
authors: DA
authors: Marshall
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy*; D003657:Decision Making; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology* / Q000517:prevention & control*; D057240:Patient Preference; D011795:Surveys and Questionnaires
chemical_list: D016179:Granulocyte Colony-Stimulating Factor
keywords: Internet survey; breast cancer; discrete choice experiment; filgrastim; granulocyte colony-stimulating factor; oncology; patient preferences; pegfilgrastim; willingness to pay