Background: To examine the preference weightings for risk/benefit attributes of therapy in metastatic prostate cancer (mPC) patients, encompassing hormone-sensitive (mHSPC) and castration-resistant (mCRPC) settings.
Patients and methods: A noninterventional cross-sectional survey employing a discrete choice experiment was conducted, recruiting 200 mHSPC and 100 mCRPC patients within 5 years of diagnosis from the urology and oncology specialty clinics between Feb 2023 and Jul 2023. Patients were randomized into 2 blocks of 9 questions, choosing 1 out of 2 medication profiles consisting 5 attributes, each with 3 levels, determined from a group interview of 5 patients. A mixed logit model estimated attribute-level preference weightings, with tradeoff points calculated.
Results: Median age was 75 (IQR:71-81), 170 (56.7%) had no income, 245 (81.7%) cared for themselves, mean maximum out-of-pocket treatment cost was US$20,456 (SD:43,568), and 160 (53.3%) claimed not to consider further treatment when cost exceeding their affordability. Patients favoured self-care ability (4.37, P < .001) and life expectancy extension (2.83, P < .001), disfavoured adverse effects (-6.97, P < .001) and treatment cost (in HK$million or USD$128,205) (-3.14, P < .001). mCPRC patients was more sensitive to treatment cost (-3.61 vs. -2.97), life expectancy extension (3.47 vs. 2.55) and adverse effects (-7.55 vs. -6.80) compared to mHSPC patients. Higher financial affordability patients exhibited higher sensitivity to self-care ability (4.89 vs. 4.02) and adverse effects (-7.57 vs. -6.70).
Conclusion: The chance of adverse effects was pivotal in treatment decisions, followed by self-care ability, with cost remaining a major access barrier.
Keywords: Androgen receptor pathway inhibitor (ARPI); Castration-resistant (mCRPC); Decision making; Hormone-sensitive (mHSPC); Prostate cancer.
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