Stated Preferences in Non-Small-Cell Lung Cancer: A Discrete Choice Experiment

The different alternatives for non-small-cell lung cancer (NSCLC) treatment can increase survival but cause important adverse events. Therefore, patients' preference can play a critical role in decision-making. Among stated preference methods, discrete choice experiment (DCE) is the most applied in health care to elicit preferences. This research aims to elicit patients' preference evaluating the trade-off between the risks (adverse events) and benefits (survival) of systemic treatments, from the perspective of Brazilian patients with locally advanced, metastatic or recurrent NSCLC.

A DCE was performed following the steps of attributes selection; construction of tasks and respondents' preference elicitation. Patients chose between 2 hypothetical treatments described by the attributes tiredness, hair loss, skin rash, hospitalization, administration mode and survival. A paper-and-pencil survey method was used to elicit the answers from the participants. The statistical data analysis used a mixed logit model to predict the relative importance of the attributes.

Most of the 65 patients interviewed were men (53.8%), mean age of 65 (95% confidence interval [CI]: 63-67) years and lung cancer stage IV (67.7%). Except for hospitalization and administration mode, the attributes coefficients were statistically significant (p < 0.005) for patients' preferences. Patients would require a minimum survival gain of 11.72 (CI: 10.28-4.22) months and 19.72 (CI: 17.31-7.09) months to accept a treatment that causes severe tiredness and severe skin rash, respectively. The market share of the treatments was calculated according to the DCE aggregate-level estimation, considering the impact of each treatment's side effects. Paclitaxel plus carboplatin had an estimated market share of 31%, followed by gefitinib (27%), erlotinib (24%) and docetaxel (18%).

In general, less than a year of survival gain would not suffice for the appearance of severe skin rash or tiredness.