Background: Oncologists and patients are frequently faced with difficult treatment decisions about expensive anticancer drugs. The aim of this study was to understand how different attributes of anticancer drugs, including their out-of-pocket costs, influenced oncologists’ recommendations.
Methods: Members of the Medical Oncology Group of Australia were invited to complete a discrete choice experiment online. Respondents were presented with 15 choice sets describing two hypothetical anticancer drugs (A or B) and were asked to indicate which they preferred to recommend to a hypothetical patient with advanced cancer. Drug B was assigned an out-of-pocket cost in most choice sets, whereas Drug A was always $0. A mixed logit model was constructed to determine the effect of different attributes and respondent characteristics on recommendations. Trade-offs between out-of-pocket cost and survival were calculated.
Results: We received 101 evaluable responses. Most respondents were fully qualified (75%) and had predominantly public (65%), metropolitan (78%) practices. Respondents were more likely to recommend anticancer drugs with longer survival (OR = 2.16 per extra month, p<0.0001) and higher chance of improvement in cancer-related symptoms (OR = 1.69 per absolute increase of 5%, p<0.0001), and less likely to recommend anticancer drugs with higher out-of-pocket costs (OR = 0.92 per extra $1000, p<0.0001) and higher chance of a serious adverse event (OR = 0.77 per absolute increase of 5%, p<0.0001). Respondents were willing to recommend anticancer drugs that would cost their patients on average $9395 (95% CI: $8586 - $10204) for each additional month of survival. Respondents only preferred Drug B over Drug A if the absolute survival gain was >2 months.
Conclusions: Australian oncologists are willing to recommend expensive anticancer drugs to their patients, exposing them to financial toxicity. A better understanding of patient preferences for expensive anticancer drugs and how oncologists can help patients determine their value is required.