title: Therapy preferences in melanoma treatment--willingness to pay and preference of quality versus length of life of patients, physicians and healthy controls.
abstract: BACKGROUND
  New melanoma therapies, like e.g. ipilimumab, improve survival. However, only a small subset of patients benefits while 60% encounter side effects. Furthermore, these marginal benefits come at a very high price of €110'000 per treatment. This study examines attitudes towards melanoma therapy options of physicians, healthy individuals and patients, their willingness to pay and preference of quality versus length of life.
  
  
  METHODS
  Based on findings from a focus group questionnaires were developed and pretested. After obtaining ethical approval and informed consent surveys were conducted in a total of 90 participants (n = 30 for each group). Statistical analyses were conducted using R.
  
  
  RESULTS
  Attitudes vastly differed between healthy participants, physicians and melanoma patients. Whereas melanoma patients show a high willingness to endure side effects despite very small survival gains (down to 1 extra week) or even only hope with no survival benefit, healthy controls are more critical, while physicians are the most therapy adverse. Consequently, if given €100'000 and the free decision what to spend the money on the willingness to pay for therapy was much higher in the patient group (68%) compared to 28% of healthy controls and only 43% of the physicians, respectively. When lowering the amount of cash that could be received instead of ipilimumab to €50'000 or €10'000 to test price sensitivity 69% (+1%) and 76% (+8%) of melanoma patients, respectively, preferred ipilimumab over cash. When judging on societal spending even melanoma patients opted for spending on ipilimumab in only 21%.
  
  
  CONCLUSIONS
  The judgment about the benefits of new treatment options largely differs between groups, physicians being the most critical against therapy. Price elasticity was low.
authors.affiliation: Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Department of Dermatology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Ramona
authors.initials: R
authors.lastname: Krammer
authors.affiliation: Department of Dermatology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Lucie
authors.initials: L
authors.lastname: Heinzerling
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001294:Attitude to Health; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D000074324:Ipilimumab; D008136:Longevity; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000191:economics; D008875:Middle Aged; D010166:Palliative Care; D010361:Patients / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000191:economics; D011795:Surveys and Questionnaires; D014839:Vomiting / Q000209:etiology; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000074324:Ipilimumab