OBJECTIVES:

To determine adjuvant immunotherapy preferences among patients with resected stage III melanoma and explore if socio-demographic and clinical characteristics influenced choices.

METHODS:

Australian consumer groups disseminated an online discrete choice task (DCE) targeting patients with resected stage III melanoma. Respondents completed 12 randomly presented choice sets of 2 alternative treatments, drug (adjuvant immunotherapy) or no drug. The DCE included 6 attributes; one with 5 levels (chance of melanoma recurrence at 3-years, levels 36%, 42%, 50%, 56%, 62%); two with 3 levels (chance of fatal adverse event (AE), levels 0%, 1%, 3%; and drug regimen, levels 0, 3, 4 weekly treatment); and three with 4 levels (chance of mild AE, levels 0%, 1%, 12%, 37%; chance of permanent AE, levels 0%, 1%, 10%, 14%; and out-of-pocket costs, levels AU$0, 750, 1500, 6000). Preferences were estimated using a D-efficient survey design and mixed multinomial logit model with 10,000 Halton draws. The marginal-rate-of-substitution and willingness-to-pay (WTP) were calculated.

RESULTS:

One hundred and sixteen respondents completed the DCE. Patients preferred immunotherapy treatment that; reduces fatal AEs (Odds Ratio (OR) 0.60, 95% CI 0.44-0.80], reduces recurrence (OR 0.76, 95% CI 0.70-0.83), reduces permanent AEs (OR 0.94, 95% CI 0.89-0.99), and has lower out-of-pocket costs for those with lower household incomes (OR 0.90, 95% CI 0.9992-0.9998). Regarding WTP, patients with lower and higher income were willing to pay an additional AU$588 and AU$1590, respectively, for adjuvant immunotherapy to reduce their chance of recurrence at 3-years by 1%.

CONCLUSIONS:

Patients preferred to reduce their chance of fatal treatment toxicity and reduce their risk of recurrence. Individual patient wishes, preferences and disease characteristics should inform clinical communication and treatment decisions. A deeper understanding of patient preferences for adjuvant immunotherapy and trade-offs; may support healthcare policies to improve access to therapies and outcomes for patients with resected melanoma.