OBJECTIVES:

To explore the preferences of Spanish healthcare professionals (haematologists and hospital pharmacists) for the treatment selection of active CLL patients at first relapse.

METHODS:

Preferences for attributes were measured using a discrete choice experiment (DCE). A literature review and focus group of 5 experts determined 7 attributes that defined 36 scenarios included in the DCE: four patient-related attributes (age, functional status, comorbidities, and risk of the disease [risk; Del17p/mutTP53 and relapse]) and three treatment-related attributes (hazard ratio of progression-free survival [HR-PFS], rate of discontinuations due to adverse events and treatment cost). Data were analyzed using the mixed logit model. Relative importance (RI) of attributes was calculated and compared between healthcare professionals. Willingness to pay (WTP) was estimated using two questions ad-hoc.

RESULTS:

A total of 130 participants, 72 haematologists [mean (SD) time of practice (yrs)= 16.8 (7.7), chief of department= 20.8%] and 58 hospital pharmacists [mean time of practice= 16.3 (9.3), chief of department= 44.8%] answered the DCE. Higher RI was obtained for treatment-related attributes, the highest rated being ‘cost’ (23.8%) followed by ‘HR-PFS’ (20.9%). Regarding patient-related attributes, the highest RI was obtained for ‘age’ (18.1%). No significant differences (p<0.05) in RI between haematologists and pharmacists were found. Ad-hoc questions showed a WTP of €41,923/year and €36,769/year for a gain of 1 year-PFS when treating a patient aged 70 and ≥80, respectively, considering a reference annual treatment cost of €20,000/year.

CONCLUSIONS:

This is the first DCE including age and cost as attributes for CLL treatment selection. ‘Cost’ and ‘HR-PFS’ (treatment-related attributes) and age (patient-related attribute) were the main factors that determine treatment selection at first relapse. WTP decreases with increasing patients’ age. Similar research in other onco-haematological diseases is recommended.