Koonal's poster for ISPOR Glasgow on cancer prevention and treatment.

1. IS WILLINGNESS TO PAY HIGHER FOR CANCER
PREVENTION AND TREATMENT?
Koonal Shah (Office of Health Economics, UK; kshah@ohe.org)
Paper: Shah, K.K., 2017. Is willingness to pay higher for cancer prevention and
treatment? Journal of Cancer Policy, 11, pp.60-64. [available open access]
[1] NICE. Appraising life-extending end of life treatments; 2009.
[2] Rawlins et al. Br J Clin. Pharmcol. 2010; 70: 346-369.
[3] Department of Health. CDF Impact Assessment; 2010.
[4] Linley & Hughes. Health Econ. 2014; 22: 948-964.
[5] Chim et al. PloS One 2017; 12(3): e0172971.
[6] Olofsson et al. Eur J Health Econ. 2017.
[7] Jones-Lee et al. Econ J. 1985; 95: 49-72.
[8] Viscussi et al. Health Econ. 2014; 23: 384-396.
CANCER AS A ‘DREAD’ DISEASE
• The question of whether cancer is worthy of special consideration has also been explored in the literature on the
value of a statistical life (VSL) and the value of a prevented fatality (VPF). The focus in this literature tends to be
on the value of reducing the total number of deaths from cancer, rather than the value of improving the health of
cancer patients.
• An influential UK study found that the majority of survey respondents prioritised reducing deaths caused by
cancer over other causes (motor accidents, heart disease).7 This study appears to have influenced the UK Health
and Safety Executive to recommend doubling the VPF when the fatality is caused by cancer.
• Based on US respondents’ willingness to pay for a reduction in risk of dying from bladder cancer, Viscussi et al.
reported evidence of a cancer premium, albeit smaller than the premia proposed for policy assessments in the UK
and the US. The authors describe cancer as a ‘dread disease’, on the grounds that “it generates a fear that is
greater than would be justified by its objective risk probabilities”.8
SUMMARY
• The evidence available is not sufficiently strong to conclude – one way or the other – whether society is willing
to pay more for cancer prevention and treatment than for other types of health care.
DO PEOPLE WISH TO GIVE HIGHER PRIORITY TO CANCER TREATMENTS?
UK POLICY CONTEXTOBJECTIVES
• It is often assumed by
health economists that the
principal objective of health
care is to maximise
population health.
• However, people may be
willing to sacrifice overall
health in order to direct
resources towards high
priority diseases (e.g.
cancer).
• Is society willing to pay
more for cancer prevention
and treatment than for
other types of health care?
• Since 2009, NICE has issued guidance that effectively gives greater
weighting to health gains generated by life-extending end of life treatments1
– apparently to reflect the ‘special value’ that society places on such
treatments.2
• Guidance is not specific to cancer, but in practice only cancer drugs have
met the criteria for special consideration.
• A Cancer Drugs Fund (CDF) is also in place – intended to improve access to
cancer medicines that have not been recommended by NICE. No other
condition has a fund dedicated to improving access to drugs.
• The purpose of the CDF is to “enable cancer treatments to be funded by the
NHS where society values their benefits more than the benefits that could be
provided by spending the funding on other treatments, elsewhere in the
NHS”.3
• In Scotland, a New Medicines Fund has been introduced to increase access to
drugs for rare or end of life conditions, including many cancers.
Text used by Linley & Hughes4 (similar text used by Chim et al.5)
Cancer vs. non-cancer disease
Imagine two diseases – Disease A and Disease B. They are both
potentially fatal, affect the same age groups and are equally common.
The number of useful medicines available to treat each disease is the
same. The only difference between the two diseases is that:
Disease A – is a type of cancer
Disease B – is some other non-cancer type of disease.
0% 20% 40% 60% 80% 100%
Linley & Hughes
Chim et al.
Prioritise cancer Equal priority Prioritise non-cancer
• A growing literature has examined whether
health gains should be weighted differently
for end of life patients, triggered in part by
the policy situation in the UK.
• However, cancer and end of life are not
synonymous, and most studies have used
unlabelled designs where the names of
conditions are not specified.
• Results of large-scale studies in the UK and
Australia challenge the rationale for a
cancer premium (see box).
• However, a recent study in Sweden
reported evidence of an end of life premium
in cancer, elicited using individual ex ante
willingness to pay methods.6
• There is a dearth of research on the social
value of treatments that seek to improve
the quality of life of cancer patients.