Assigning value to preparation for prostate cancer decision making: a willingness to pay analysis.

The Personal Patient Profile-Prostate (P3P) is a web-based decision support system for men newly diagnosed with localized prostate cancer that has demonstrated efficacy in reducing decisional conflict. Our objective was to estimate willingness-to-pay (WTP) for men's decisional preparation activities.

In a multicenter, randomized trial of P3P, usual care group participants received typical preparation for decision making plus referral to publicly-available, educational websites. Intervention group participants received the same, plus online P3P educational media specific to the user's personal preferences and values, and a communication coaching component tailored to race\ethnicity, age and language. WTP data were collected one week after physician consultation. An iterative bidding direct contingent valuation survey format was used, randomly assigning participants to high or low starting values (SV). Tobit models were used to explore associations between SV-adjusted WTP and age, education, marital and work-status, insurance, decision-control preference and decision-making stage.

Of 392 participants enrolled, 141 P3P and 107 usual care (UC) provided a WTP value. Men were willing to pay a median $25 (IQR $10-100) for P3P in addition to usual care preparation materials. In the final multivariable tobit regression model, SV, marital status, stage of decision making and income were significantly associated with WTP for P3P. Decision control preference was considered marginally significant (p = 0.11). Men were WTP a median $30 (IQR $10-$200) for usual care material alone. In the final multivariable model, SV, education, and stage of decision making were significantly associated with WTP in usual care.

WTP was similar for UC and for the addition of P3P to UC decision preparation. The WTP values were associated with demographic and preference variables. Findings can help focus decision support on future patients who would benefit most: those without strong support systems, at earlier stages of decision making, and open to a shared-decision style.

NCT NCT01844999 . Registered May 3, 2013.

BMC medical informatics and decision making. 2019 Jan 09*** epublish ***

Leslie S Wilson, Traci M Blonquist, Fangxin Hong, Barbara Halpenny, Seth Wolpin, Peter Chang, Christopher P Filson, Viraj A Master, Martin G Sanda, Gary W Chien, Randy A Jones, Tracey L Krupski, Donna L Berry

University of California San Francisco, 2130 Fulton St, San Francisco, CA, 94117, USA., Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA., University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA., Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA., Emory University School of Medicine, 1365 Clifton Rd NE, Suite B1400, Atlanta, GA, 30322, USA., Kaiser Permanente Medical Center, 4867 Sunset Blvd, Los Angeles, CA, 90027, USA., University of Virginia, 202 Jeanette Lancaster Way, Charlottesville, VA, 22908, USA., Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA. .