Measuring Treatment Preferences and Willingness to Pay for Docetaxel in Advanced Ovarian Cancer

Abstract

Background: Docetaxel is an equally active alternative to paclitaxel in advanced ovarian cancer but has a different adverse effect profile. Whilst paclitaxel is associated with less haematological toxicity, such as febrile neutropenia and anaemia, docetaxel causes less sensory and motor neuropathy.

Objective: To measure the economic value and preference scores for docetaxel as an alternative to paclitaxel in patients with advanced ovarian cancer.

Design and setting: A cost-benefit analysis using a consumer-based willingness-to-pay (WTP) approach was conducted. The study population consisted of a patient surrogate sample comprised of 80 oncology pharmacists and nurses from eight Canadian provinces. Background information on ovarian cancer was provided including its current management, and differences in adverse effects between docetaxel and paclitaxel. Respondents were then asked what their preferred product would be if they were diagnosed with ovarian cancer and how much they would be willing to pay per cycle for six cycles in the form of a co-payment (i.e. user’s fee) for the product of their choice. The maximum willingness to pay for docetaxel was then compared against the incremental cost (acquisition and administration) of the drug.

Study perspective: Canadian healthcare system perspective.

Main outcome measures and results: The WTP survey instrument was simple to administer and easily understood by participants. Respondents ranked motor neuropathy as being the most unpleasant adverse effect of treatment. Of the sample, 63.8% preferred to use docetaxel instead of paclitaxel (p = 0.075). The patient surrogate sample was willing to pay a mean of 64 Canadian dollars ($Can; 2003 values) [95% CI $Can33, $Can92] per cycle for the benefits offered by docetaxel as an alternative to paclitaxel. This estimate was marginally lower than the incremental cost of $Can87 per cycle of docetaxel.

Conclusion: A substantial portion of Canadian patients with ovarian cancer would likely prefer to be treated with docetaxel instead of paclitaxel for the management of their disease and would be willing to pay a portion of the incremental cost. Therefore, both options should be offered to patients, and selection of treatment can be based on reducing the risk of the toxicity that concerns the patient the most.

Appendix

Clinical Scenario Presented to Questionnaire Respondents

The background information on the characteristics of paclitaxel (drug A) and docetaxel (drug B) that was presented to the respondents is shown in table AI.

Table A1

Background information on drug characteristics provided to respondents to answer the question: “which protocol would you prefer if you had ovarian cancer?”

The respondents were then presented with the following clinical scenario:

“Imagine that you have been diagnosed with advanced ovarian cancer and your oncologist has recommended that you start platinum-based chemotherapy. This consists of receiving up to 6 cycles every 3–4 weeks. Your oncologist informs you that the platinum-based regimen available can be with either drug A or drug B. Drug A requires a longer infusion time than Drug B (3 hours vs 1 hour). Both agents require that patients be premedicated with corticosteroids alone, or combined with antihistamines and ranitidine.”

Respondents were then asked “which protocol would you prefer if you had ovarian cancer?”.