Perceptions of Value in Cancer Care Across Distinct Health Systems: A Comparison of Providers in High- and Low- and Middle-Income Countries.

Abstract

Value in health care is a multifaceted concept encompassing patient outcomes, treatment effectiveness, and costs. However, the definition of value can vary between distinct health systems. We compared the perceptions of value in cancer care between providers in high-income countries (HICs) and low- and middle-income countries (LMICs). A novel survey assessed the relative importance of health care priorities, including longevity, experience, functional and emotional well-being, costs to patients, and costs to the health system between providers in HICs and LMICs. Kendall's coefficient of concordance assessed agreement between groups. We received 365 responses: 216 (59.2%) from HICs and 149 (40.8%) from LMICs. HIC providers more frequently rated treatment experience (82.9% <i>v</i> 65.1%) and patient functional independence (72.7% <i>v</i> 59.7%) as extremely important, while fewer rated emotional well-being (65.3% <i>v</i> 78.5%) and costs to the health system (26.4% <i>v</i> 51.7%) as such (all <i>P</i> < .050). With consensus (HIC: W = 35%; <i>P</i> < .001; LMIC: W = 19%; <i>P</i> < .001), both cohorts ranked patient emotional well-being (2.56 ± 1.30 HIC <i>v</i> 2.74 ± 1.58 LMIC; <i>P</i> = .254) as the most important priority. HICs placed higher priority on treatment experience (3.02 ± 1.55 <i>v</i> 3.59 ± 1.47; <i>P</i> < .001) and less on costs to the health system (5.56 ± 1.15 <i>v</i> 4.97 ± 1.44; <i>P</i> < .001), when compared with LMICs. Although there is consensus on the importance of patient-centered outcomes, the prioritization of treatment experience and costs of care to the health system differ between HICs and LMICs. These findings underscore the importance of developing adaptable value frameworks that are relevant and effective across diverse health care settings.