Kozminski MA, Neumann PJ, Nadler ES, Jankovic A, Ubel PA. How long and how well: oncologists' attitudes toward the relative value of life-prolonging v. quality of life-enhancing treatments.
Med Decis Making 2010;
31:380-5. [PMID:
21088130 DOI:
10.1177/0272989x10385847]
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Abstract
OBJECTIVE
To determine how oncologists value quality-enhancing v. life-prolonging outcomes attributable to chemotherapy.
METHODS
The authors surveyed a random sample of 1379 US medical oncologists (members of the American Society of Clinical Oncology), presenting them with 2 scenarios involving a hypothetical new chemotherapy drug. Given their responses, the authors derived the implicit cost-effectiveness ratios each physician attributed to quality-enhancing and life-prolonging chemotherapies.
RESULTS
The authors received responses from 58% of the oncologists surveyed. On average, the responses implied that oncologists were willing to prescribe treatments that cost $245,972 per quality-adjusted life-year (QALY; SD $243,663 per QALY) in life-prolonging situations v. only $119,082 per QALY (SD $197,048 per QALY) for treatments that improve quality of life but do not prolong survival (P < 0.001). This difference did not depend on age, gender, percentage of time in clinical work, or self-reported preparedness to use and interpret cost-effectiveness information (P > 0.05 for all specifications). Differences across these situations persisted even among those who considered themselves to be "well-prepared" to make cost-effectiveness decisions.
CONCLUSION
Cost-effectiveness thresholds for oncologists vary widely for life-prolonging chemotherapy compared to treatments that only enhance quality of life. This difference suggests that oncologists value length of survival more highly than quality of life when making chemotherapy decisions.
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