Willingness to Pay for Cancer Prevention, Screening, Diagnosis, and Treatment: A Systematic Review

OBJECTIVES: Willingness to pay (WTP) studies elicit the maximum amount of money an individual is willing to pay for a specified health intervention, and may be used to inform coverage and reimbursement decisions. Our objective was to assess how people value cancer-related prevention, screening, diagnosis and treatment; to identify differences in the methodology used to estimate WTP; and to review the trends in publication of WTP studies for these interventions.

METHODS: We searched PubMed and EconLit for articles, published through 2020 reporting the WTP for cancer-related prevention, screening, diagnosis and treatment. We characterized methodological differences across studies and summarized mean and median WTP values for each intervention.

RESULTS: We reviewed 1,331 abstracts and identified 103 relevant WTP studies, of which: 37 (36%) focused on treatments, while others analyzed screening (n=26, 25%), prevention (n=21, 20%), diagnosis (n=7, 7%) and other interventions (n=12, 12%). Methods used to elicit WTP values were primarily discrete-choice questions (n=54, 52%), bidding game (n=15, 15%), payment card (n=12, 12%) and open-ended questions (n=12, 12%). Higher income, education, age, disease severity, perceived disease risk and family history of cancer were in general associated with higher WTP values for treatment. All 103 studies reported mean and/or median WTP values, with a wide variation in WTP values. The median WTP value for cervical, breast and colorectal cancer interventions (treatment/screening/prevention/diagnosis) ranged from below $100 to over $20,000.

CONCLUSIONS: The WTP literature of cancer-related interventions has grown rapidly, and suggests that people place considerable value on these interventions. There exists, however, a great heterogeneity with respect to the type of interventions and disease assessed, respondent characteristics, and study methodology. The perceived value of cancer-related interventions seems to be influenced also by the study design and elicitation methods. Therefore, there is a need for international guidelines shaping the recommended practices in this research field.