A multinational study to measure the value that patients with cancer placeon improved emesis control following cisplatin chemotherapy

Background: The neurokinin-1 (NK1) receptor antagonists are a new class of agents designed to reduce the risk of emesis following chemotherapy, partic ularly with cisplatin. Early data from double-blind randomised trials sugge st that an orally administered NK1 antagonist can reduce the absolute risk of acute and delayed emesis following cisplatin by 20 and 30%. respectively . Objective: To measure the value that patients with cancer place on improved emesis control and quality of life. Design: Willingness-to-pay analysis. Setting: Five study sites in Canada, Italy, Spain and Greece. Patients and participants: 245 patients with cancer either receiving chemot herapy with cisplatin or who had received cisplatin-based chemotherapy with in the previous 6 months. Methods: After background information had been presented, patients were ask ed to define the maximum that they would pay per day for a drug that reduce d their risk of acute and delayed (days 2 to 5) emesis by 20 and 30%, respe ctively. Costs were converted to US dollars ($US) using year 2000 exchange rates, Results: For a 20% improvement in acute emesis, Canadian, Italian and Spani sh patients with cancer were willing to pay $US46, $US34 and $US63 per day, respectively, compared with $US8 for patients from Greece (p < 0.001). For a 30% improvement in delayed emesis, Canadian, Italian and Spanish patient s with cancer were also willing to pay more than their Greek counterparts ( $US41. $US31, $US50 and $US9 daily for 4 days, respectively; p < 0.001). Th ese significant differences in patient value between countries remained, ev en after adjusting for socioeconomic variables and previous history of emes is. Conclusions: There are substantial cultural differences in how patients wit h cancer value benefit and improved quality of life. Since the majority of the world's population resides outside North America and Western Europe, th ere may be a need to re-evaluate perceived levels of patient benefit and me asures of quality of life.