OBJECTIVES:

Treatment decisions in Chronic Lymphocytic Leukemia (CLL) include both patient and treatment characteristics. However, the value professionals place upon these attributes is largely unknown. We aimed to explore the priorities of Spanish healthcare professionals in treatment decision-making for CLL patients at first relapse.

METHODS:

A committee of five experts was involved in the design of an electronic questionnaire containing six ad-hoc and three 5-point Likert-scale (importance and frequency) questions. Three main attributes for decision-making were assessed: patient age, performance status and treatment cost. Likert-scale responses were described using relative and absolute frequencies. Values 4-5 of the importance scale defined the category "important”, and values 3-5 of the frequency scale defined the category “modifies/hinders”. Performance status influence on the age limit for treatment recommendation was estimated and described using mean (+/- SD). Willingness-to-pay (WTP) for progression-free survival (PFS) benefits was described using a weighted mean.

RESULTS: In patients with good performance status, professionals would recommend chemo-immunotherapies until age 80.9 years and new targeted therapies until 86.5. However, for patients with poor performance status, these age thresholds dropped to 75.2 and 82.1 years, respectively.

For one extra-year of PFS with respect to standard treatment, professionals’ average WTP for a new treatment was 14.0% higher for younger (aged 70) than older (aged ≥80) patients (€41,923 vs. €36,769, respectively).

CONCLUSIONS:

Age, performance status and cost strongly influence treatment selection in first-relapse CLL. Advanced age negatively impacts the WTP for CLL treatments, while performance status limits the access to treatment approaches. Knowledge of professionals’ priorities in treatment decision-making may improve disease management.