ASCO--Researchers at Virginia Commonwealth University's Massey Cancer Center have launched what is believed to be the first willingness-to-pay study done in a real-life setting. Thomas J. Smith, MD, reported on potential problems created by the innovative study design at a scientific session of the ASCO annual meeting in Philadelphia.
All patients in the study, designed by Dr. Smith and attorney Karen Swisher, must be insured by the co-sponsor Trigon Blue Cross/Blue Shield and must have a terminal cancer with "absolutely no option of curative therapy," Dr. Smith said.
Patients will be randomized to either stay with their fee-for-service insurance or to cash in their insurance policy for a lump sum "indemnity" payment of approximately $18,000.
Patients randomized to the lump sum payment can do whatever they want with the money, "save it, buy a boat, give it to their grandchildren," Dr. Smith said, but if they want palliative chemotherapy or radiotherapy, then it must be paid for from the lump sum. This is analogous to the proposed "medical IRAs" in which patients would purchase care out of their own funds, he said
As an ethical protection, all patients will receive hospice care. Furthermore, if the lump sum is spent on treatment that is producing positive results, the patient may continue on standard insurance to avoid the risk of depleting the indemnity fund. Patients can also convert back to standard insurance by repaying the indemnity, "but they would have to sell the boat or otherwise raise the money," Dr. Smith said.
An additional randomization is to standard or advanced patient education, to see if such information better informs their decision making. The primary endpoints are quality of life, patient satisfaction, and cost of care.
The researchers plan to enroll 120 patients over the next 3 years, and the study team is now working with primary care physicians and pulmonary physicians to enhance accrual.