PMID- 37351797 OWN - NLM STAT- MEDLINE DCOM- 20230809 LR - 20231213 IS - 1178-1661 (Electronic) IS - 1178-1653 (Print) IS - 1178-1653 (Linking) VI - 16 IP - 5 DP - 2023 Sep TI - Preferences for Adjuvant Immunotherapy in Adults with Resected Stage III Melanoma-A Discrete Choice Experiment. PG - 497-513 LID - 10.1007/s40271-023-00635-w [doi] AB - OBJECTIVES: This study aimed to quantify adult preferences for adjuvant immunotherapy for resected melanoma and the influence of varying levels of key attributes and baseline characteristics. METHODS: A D-efficient design generated 12 choice tasks for two alternative treatments, adjuvant immunotherapy or no adjuvant immunotherapy. Recruitment to the online discrete choice experiment (DCE) occurred via survey dissemination by eight Australian melanoma consumer and professional groups, targeting adults with resected stage III melanoma, considering or having received adjuvant immunotherapy. The DCE included six attributes with two to three levels each, including 3-year risk of recurrence, mild, permanent and fatal adverse events (AEs), drug regimen and annual out-of-pocket costs. A mixed multinomial logit model was used to estimate preferences and calculate marginal rates of substitution and marginal willingness to pay (mWTP). RESULTS: The DCE was completed by 116 respondents, who chose adjuvant immunotherapy over no adjuvant immunotherapy in 70% of choice tasks. Respondents preferred adjuvant immunotherapy when associated with reduced: probabilities of recurrence, permanent and fatal AEs, and out-of-pocket costs. mWTP for an absolute reduction of 1% in 3-year risk of recurrence was less for respondents with lower rather than higher incomes, AU$794 (US$527) and AU$2190 (US$1454) per year. Respondents accepted an additional 4% chance of a permanent AE to reduce their absolute risk of 3-year recurrence by 1%. Respondents were willing to accept an extra 2% chance of 3-year recurrence to lower their chance of a fatal AE by 1%. CONCLUSIONS: Almost three-quarters of respondents chose adjuvant immunotherapy over no adjuvant immunotherapy, preferring treatment that improved efficacy and safety. Findings may inform decisions about access to adjuvant immunotherapy following surgery for melanoma. CI - (c) 2023. The Author(s). FAU - Livingstone, Ann AU - Livingstone A AUID- ORCID: 0000-0002-6836-0382 AD - Faculty of Health, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, VIC, Australia. a.livingstone@deakin.edu.au. AD - Faculty of Health and Medicine, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia. a.livingstone@deakin.edu.au. FAU - Howard, Kirsten AU - Howard K AUID- ORCID: 0000-0002-0918-7540 AD - School of Public Health, The University of Sydney, Sydney, NSW, Australia. AD - Faculty of Health and Medicine, Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, NSW, Australia. FAU - Menzies, Alexander M AU - Menzies AM AUID- ORCID: 0000-0001-5183-7562 AD - Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. AD - Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. AD - Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia. FAU - Long, Georgina V AU - Long GV AUID- ORCID: 0000-0001-8894-3545 AD - Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. AD - Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. AD - Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia. FAU - Stockler, Martin R AU - Stockler MR AUID- ORCID: 0000-0003-3793-8724 AD - Faculty of Health and Medicine, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia. AD - Central Clinical School, The University of Sydney, Sydney, NSW, Australia. FAU - Morton, Rachael L AU - Morton RL AUID- ORCID: 0000-0001-7834-0572 AD - Faculty of Health and Medicine, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia. AD - Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230623 PL - New Zealand TA - Patient JT - The patient JID - 101309314 SB - IM MH - Adult MH - Humans MH - Australia MH - *Melanoma/surgery/drug therapy MH - *Skin Neoplasms/surgery MH - Immunotherapy/adverse effects MH - Choice Behavior MH - Patient Preference MH - Melanoma, Cutaneous Malignant PMC - PMC10409831 OAB - Melanoma is the deadliest type of skin cancer. Treatment for melanoma involves surgery to remove it and can be followed by extra (adjuvant) immunotherapy, a type of drug that uses the body's immune system to fight any leftover melanoma. Immunotherapy can help a person live longer (benefits) but has downsides or side-effects (risks) that may need a person to take daily medication for life. We surveyed people with melanoma to learn what was important to them and which immunotherapy treatment risks were acceptable in order to gain benefits (trade-offs). People preferred treatment that lowered the chance of the melanoma returning and lowered the chance of dying from a treatment side-effect. People accepted an extra 4% (4 per 100) chance of a life-long treatment side-effect to lower the chance of their melanoma returning by 1% (1 per 100). This information will help doctors, nurses and governments to consider what treatment options are available to people with melanoma and their families. OABL- eng COIS- AL, RLM and KH have no financial disclosures. AMM served on BMS, MSD, Novartis, Roche, Pierre-Fabre and QBiotics advisory boards. GVL is a consultant advisor for Amgen, Array Biopharma, Boehringer Ingelheim, BMS, Hexel AG, Highlight Therapeutics SL, MSD, Novartis, Pierre-Fabre, Provectus, QBiotics, Regeneron Pharmaceuticals and Specialised Therapeutics Australia. MRS received institutional research support from Amgen, Astellas, AstraZeneca, Bayer, Bionomics, BMS, Celgene, Medivation, MSD, Pfizer, Roche, Sanofi and Tilray but did not sit on any advisory boards. EDAT- 2023/06/23 13:07 MHDA- 2023/08/09 06:43 PMCR- 2023/06/23 CRDT- 2023/06/23 11:14 PHST- 2023/05/18 00:00 [accepted] PHST- 2023/08/09 06:43 [medline] PHST- 2023/06/23 13:07 [pubmed] PHST- 2023/06/23 11:14 [entrez] PHST- 2023/06/23 00:00 [pmc-release] AID - 10.1007/s40271-023-00635-w [pii] AID - 635 [pii] AID - 10.1007/s40271-023-00635-w [doi] PST - ppublish SO - Patient. 2023 Sep;16(5):497-513. doi: 10.1007/s40271-023-00635-w. Epub 2023 Jun 23.