DOES FRAMING OF CANCER SURVIVAL AFFECT PERCEIVED VALUE OF CARE? COMPARING RESPONDENTS WITH AND WITHOUT CANCER

Purpose: Message framing can affect patient comprehension of information and treatment decisions.  We investigated the relationship between the framing of survival gains and the perceived value placed on cancer care, and examined whether the perceived value differ by prior cancer diagnosis.

Method: We conducted an internet-based, population survey of 2,050 U.S. adults (50% with cancer history).  Respondents were randomized to one of two sets of hypothetical scenarios, each of which described the survival benefit for a new treatment as either an increase in median survival time (median survival), or an increase in the probability of survival for a given length of time (landmark survival), over standard therapy.  Each respondent was presented with two randomly selected scenarios with different baseline and survival improvements, and asked about their willingness-to-pay (WTP) for the new treatments.  We used a double-bounded, dichotomous-choice bidding game to elicit WTP and performed a two-part model to examine factors influencing WTP.

Result: Predicted WTP increased with survival benefits and respondents’ income, regardless of how survival benefits were described.  Framing therapeutic benefits in terms of improvements in landmark rather than median time survival increased the proportion of the population willing to pay for that gain by 11%-35%, and the mean WTP amount by 42%-72%.  Respondents with a prior diagnosis of cancer were more likely to pay some amount for therapy that conferred survival benefit (OR=1.44, p<0.01), but their mean WTP did not differ from respondents with no history of cancer.  88% of cancer survivors stated that treatment success was a very important or important factor in deciding whether and how much to pay, compared to 84% among non-cancer respondents (p<0.01).  Approximately 80% indicated that affordability of treatment was a very important or important consideration, regardless of cancer history.

Conclusion: How survival benefits are described may influence the value people place on cancer care.  People may be willing to pay more for therapy if benefits are described as an increase in landmark survival probability than they would if the benefit is described as an increase in median survival time.  Although individuals with a prior cancer diagnosis may be more inclined to pay out-of-pocket for cancer treatment that confers additional survival advantage, the amount an individual would pay appeared to be independent of personal cancer history.