Cancer Patients’ Trade-offs Among Efficacy, Toxicity, and Out-of-Pocket Cost in the Curative and Noncurative Setting

• DOI: 10.1097/mlr.0b013e31829faffd
• Publication Date: 2013-07-18T11:19:19Z
• Authors: Yu-Ning Wong; Brian L. Egleston; Kush Sachdeva; Naa Eghan; Melanie Pirollo; Tammy K. Stump; John Robert Beck; Katrina Armstrong; Jerome Sanford Sc...; Neal J. Meropol
• Keywords: Stylized fact

Background: When making treatment decisions, cancer patients must make trade-offs among efficacy, toxicity, and cost. However, little is known about what patient characteristics may influence these trade-offs. Methods: A total of 400 reviewed 2 3 stylized curative noncurative scenarios that asked them to choose between treatments varying levels Each scenario included 9 choice sets. Demographics, cost concerns, numeracy, optimism were assessed. Within each scenario, we used latent class methods distinguish groups with discrete preferences. We then regressions group membership probabilities as covariates identify associations. Results: The median age the was 61 years (range, 27–90 y). Of number included, 25% enrolled at a community hospital, 99% insured. Three classes identified demonstrated (1) preference for survival, (2) aversion high cost, (3) toxicity. Across all scenarios, higher income more likely be in favored survival. Lower averse (P<0.05). Similar associations found education, employment status, class. Conclusions: Even socioeconomic status predicted choice. Higher focus on whereas those lower avoid expensive treatment, regardless survival or This raises possibility insurance plans greater cost-sharing have unintended consequence increasing disparities care.