Assessment of the Value of Tumor Variation Profiling Perceived by Patients With Cancer
Authors: Phyllis Butow, Grace Davies, Christine E. Napier, Timothy Schlub, Megan C. Best, Nicole Bartley, Ilona Juraskova, Bettina Meiser, Mandy L. Ballinger, Barbara Biesecker, David Goldstein, David M. Thomas
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Use of tumor molecular profiling (MP) is entering routine clinical practice; however, little is known about how much and why patients value MP. <h3>Objective</h3> To examine the perceived value of MP to patients with advanced cancer and factors associated with perceived value. <h3>Design, Setting, and Participants</h3> A cross-sectional survey that included willingness-to-pay trade-off scenarios was administered to participants after consent and before MP. A total of 777 participants (94% response rate) were recruited from the Molecular Screening and Therapeutics Program. Eligible patients had advanced solid cancers of any histologic type, were receiving or had completed their last line of effective therapy, had an Eastern Cooperative Oncology Group Performance Status 0 to 3, and had sufficient accessible tissue for MP. The participants were recruited between October 24, 2017, and March 12, 2019, and data analysis was conducted from March 13 to April 14, 2019. <h3>Main Outcomes and Measures</h3> Willingness to pay for MP was assessed via hypothetical trade-off scenarios varying in the actionable return rate (1%, 20%, or 40%) and cost (A$0, A$300 [US$210], A$1000 [US $700], A$3000 [US $2100], or A$10 000 [US $7000]). Ordinal regressions were used to explore factors associated with willingness to have and pay for MP. <h3>Results</h3> Of 777 participants (405 women [52%]; mean [SD] age, 55.47 [14.26] years), 689 patients (89%) would have MP for as little as a 1% actionable return rate. Fifty-six patients (7%) would require at least a 20% return rate and 11 patients (1%) would require at least a 40% return rate. Fifteen patients (2%) consistently chose not to have the test; 6 participants (0.8%) had missing values on this item. Participants were willing to pay a median of A$1000 if the actionable return rate was 1% and A$3000 for an actionable return rate of 20% to 40%. Of 762 individuals who agreed to testing, 482 patients (64%) were consistently unwilling to pay A$10 000, regardless of the actionable return rate. Patients born in Australia or New Zealand were more likely to want MP (eg, participants born in South Asia had an ordered odds for the tipping point of 7.74 [95% CI, 1.67-36.05;<i>P</i> = .009] times higher than Australian- and/or New Zealand–born participants). Patients born in Australia or New Zealand were also more willing to pay A$1000 or A$3000 (eg, participants born in Western Europe had an ordered odds for the tipping point for paying A$1000 of 1.74 [95% CI, 1.01-3.00;<i>P</i> = .048] times higher than Australian- and/or New Zealand–born participants). People with a medical- or science-related occupation and with more negative attitudes toward uncertainty were more likely to pay A$10 000 (eg, A$10 000 tipping point–ordered odds of participants with a medical- or science-related occupation was 0.49 [95% CI, 0.7-0.87;<i>P</i> = .02] times that of participants without a medical- or science-related occupation). <h3>Conclusions and Relevance</h3> This study found apparent high interest in but lower willingness to pay for MP among patients with advanced cancer. Ability to pay may limit access to MP. Ongoing societal debate is required to establish the value of MP and whether subsidization is needed to ensure equity of access.