OBJECTIVES : To quantify value of hope as a construct for potential use in value assessment frameworks.

METHODS : We designed a discrete-choice experiment in which pairs of treatment alternatives were constructed using probabilities of achieving long-term (i.e. 10-year) survival (0%, 5%,10%, and 20%) and the corresponding probabilities and durations of short-term survival such that expected survival for the alternative equaled 2, 3, or 5 years. Other attributes were health status and out-of-pocket cost, representing 0%, 10%, 30% or 80% of participants’ reported annual income. Each participant was randomly assigned to one of 12 blocks of 10 choice questions. Following a pilot study in 120 adults, 200 patients with cancer or history of cancer were recruited by Cancer Support Community. We computed dollar-equivalent values for treatments offering 5%, 10% and 20% chances of long-term survival versus a 0% chance of long-term survival (i.e. guaranteed 2-, 3- or 5-year survival). We evaluated preference heterogeneity using mixed-logit and latent-class models.

RESULTS : Participants’ choices implied that they preferred a 5% versus a 0% chance of long-term survival (p=0.054) and a 10% versus a 0% chance of long-term survival (p=0.001) when holding expected survival constant. However, participants did not indicate a preference for treatments offering a 20% versus a 0% chance of long-term survival (p=0.38) due to the offsetting 80% chance of shorter survival to maintain the same duration of expected survival. Compared to a 0% chance, dollar-equivalent values were $5,975 (95%CI: -145 to 12,629) for a 5% chance and $12,421 (95%CI: 5,082 to 20,744) for a 10% chance of long-term survival, independent of health status or expected survival. Latent-class analysis revealed 4 groups with distinct preference patterns.

CONCLUSIONS : Independent of expected survival and health status, patient preferences are consistent with positive value for hope. However, this finding does not universally hold in all situations nor across individuals.