Patient and Clinician Preferences for Adjuvant Immunotherapy as Treatment of Stage III Melanoma

Patient preferences are used to inform healthcare funding decisions, contribute to value assessment, and determine end-user acceptability of treatment. Understanding the preferences for adjuvant immunotherapy of patients with stage III resected melanoma and their clinicians is essential to inform clinical decision-making and healthcare delivery. Factors and preferences that influence treatment decision-making for patients, carers and clinicians regarding adjuvant immunotherapy [Chapters 3–5] Three studies established the concepts instrumental in immunotherapy decision-making. First, a systematic review of the factors melanoma patients and their clinicians considered in immunotherapy decisions revealed that overall survival was of primary importance, followed by impaired quality of life due to toxicity. Second, patient and carer focus groups revealed influential aspects for immunotherapy, including living longer, toxicity, out-of-pocket [OOP] costs and uncertainty about efficacy. Third, interviews with melanoma clinicians highlighted that the disease sub-stage and treatment benefits versus risks drove their treatment recommendations. Preferences and trade-offs for adjuvant immunotherapy among patients with resected stage III melanoma [Chapter 6] One hundred and sixteen patients completed a discrete choice experiment [DCE] with two treatment options—adjuvant immunotherapy or observation without adjuvant immunotherapy. Three-quarters of the sample chose immunotherapy. The DCE included six attributes: chance of reducing melanoma recurrence; mild, permanent, or fatal adverse events [AEs]; annual OOP costs; and drug regimen. Immunotherapy was preferred if the absolute risk reduction for recurrence and the chance of fatal AEs were lower. Patients accepted a 4% increase in the chance of a permanent AE to reduce their risk of 3-year recurrence by 1%. Conclusions Treatment features, including reduced risk of melanoma recurrence, reduced chance of permanent and fatal AEs, and decreased yearly OOP costs, positively influenced the choice for adjuvant immunotherapy. Understanding patient preferences facilitates the alignment of healthcare policies to improve health outcomes for people with resected stage III melanoma.