Patient willingness to pay and preference for cervical cancer treatments among middle- and low-income populations in Xinjiang.

Abstract

Background: Cervical cancer remains a significant public health issue in underdeveloped regions like Xinjiang, Western China, where health literacy is low and economic disparities are prominent. While previous studies have focused on preventive measures, there is limited research on the willingness to pay (WTP) for cervical cancer treatments. This study aimed to assess patient preferences and WTP from patient perspective for quality of life improvement, unadjusted life-year extension, and targeted and immunotherapy drugs among cervical cancer patients in Xinjiang.

Methods: A face-to-face survey was conducted using the Contingent Valuation Method (CVM) and Discrete Choice Experiment (DCE) to evaluate WTP for cervical cancer treatments. The CVM assessed patients' WTP for two scenarios: living in perfect health for 5 or 10 years versus unadjusted life-year extension for the same durations. Health related quality of life (HRQoL) was measured using both the EQ-5D-5 L and EQ-VAS instruments. The DCE evaluated patients' preferences and WTP for targeted therapy and immunotherapy drugs.

Results: This study included 106 valid questionnaires (response rate 96.4%), primarily comprising stage III cervical cancer patients (EQ-5D-5 L 0.89, EQ-VAS 0.80) with characteristics of low income and educational attainment. Key findings revealed: (1) Patients prioritized quality of life improvement over lifespan extension, with WTP/QALY in the 10-year perfect health scenario exceeding Xinjiang's 2024 per capita disposable income threshold while other scenarios remained below this value, and WTP/QALY being significantly higher in the 10-year scenario compared to the 5-year scenario; (2) Medication preference analysis demonstrated that quality of life improvement, cost, and incidence of adverse reactions were key decision-making factors, whereas survival extension held relatively lower importance. WTP valuations exhibited significant attribute-specific variations, with the highest WTP corresponding to quality of life improvement attributes and the lowest to survival extension attributes.

Conclusions: Cervical cancer patients in Xinjiang prioritize quality of life improvement over lifespan extension, with their preferences and WTP being influenced by treatment-related factors, disease characteristics, and socioeconomic background. Therefore, when formulating reimbursement policies and resource allocation strategies, priority should be given to interventions that can significantly improve quality of life, while implementing differentiated support policies for patient populations with varying socioeconomic statuses.