OBJECTIVES : To compare the value that healthy individuals place on insurance coverage of novel lung cancer treatments relative to the expected valuation of treatment coverage from individuals with lung cancer.

METHODS : A web-based survey was administered to two cohorts of adults in the United States: (i) individuals at-risk for lung cancer and (ii) individuals with lung cancer. A multiple random staircase survey design was used to elicit respondent willingness to pay—in terms of monthly premiums—for coverage of novel lung cancer therapies associated with survival gains. Calibration was based on a non-small cell lung cancer clinical trial of nivolumab. The novel therapy in our survey had an estimated 15% five year survival versus standard-of-care chemotherapy of only 4% five-year survival.

RESULTS : Of the 84,937 individuals in the at-risk cohort invited, 300 completed the survey and met all eligibility criteria. Of the 36,249 in the lung cancer cohort invited, 250 completed the survey and met all eligibility criteria. Median age by cohort was 50.5 and 45.0 years, and 55.0% and 47.2% were female, respectively. Using an interval regression model, estimated willingness to pay for the at-risk and lung cancer cohorts was $57.97 (95% confidence interval (CI): $52.38-$63.58) and $12,309 (95% CI: $10,861-$13,757) per month, respectively, for coverage of the novel therapy. The annual value of generous insurance coverage of lung cancer treatments for all U.S. adults (233.3m) was $162.3 billion. Assuming annual lung cancer incidence of 0.07% and using the lung cancer patient cohort willingness to pay, the risk neutral expected value of generous coverage was $16.5 billion. In other words, the surplus value of generous insurance coverage for healthy individuals comprised 89.8% of overall value of lung cancer treatments.

CONCLUSIONS : Failing to account for individual risk preferences underestimates the value of generous coverage of novel lung cancer therapies.