SSAT - EXPLORING THE PERCEPTION OF VALUE IN CANCER CARE ACROSS HIGH AND LOW-MIDDLE INCOME COUNTRIES

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EXPLORING THE PERCEPTION OF VALUE IN CANCER CARE ACROSS HIGH AND LOW-MIDDLE INCOME COUNTRIES
Edward A. Joseph^*¹, Muhammad Anees¹, Shayan Shah², Saqib Bakhshi², Adil Haider², David Bartlett³, Casey Allen³
¹Allegheny-Singer Research Institute, Pittsburgh, PA; ²The Aga Khan University, Karachi, Sindh, Pakistan; ³Allegheny Health Network, Pittsburgh, PA

Introduction
Value-based care emphasizes optimizing outcomes in a cost-efficient manner. However, the definition of "value" can vary between distinct healthcare systems. We compared the perceptions of "value" in cancer care between providers in a high-income country (HIC) and a low-middle-income country (LMIC).
Methods
Providers were asked to rank order various care priorities including longevity, experience, functional and emotional well-being, and costs to both the patient and health-system. Kendall�s co-efficient of concordance (W) was used to assess agreement among respondents. The relative importance of these priorities was compared between providers in a HIC (United States) and a LMIC (Pakistan).
Results
297 providers responded. The HIC cohort (n=216) included physicians (29%), nurses (21%), advanced practice providers (11%), and researchers (9%). The LMIC cohort (n=81) comprised physicians (85%), nurses (4%), and researchers (11%). With moderate consensus, both cohorts placed top priority on patient emotional and functional well-being (HIC: W=35% [p<0.001]; LMIC: W=27% [p<0.001]). Both cohorts reported similar mean rank order for emotional well-being (2.6�1.3vs2.7�1.5, p=0.473), functional well-being (3.0�1.4vs2.7�1.6, p=0.152), longevity/survival (3.1�1.7vs2.9�1.7, p=0.353), and costs to patients (3.7�1.3vs3.8�1.5, p=0.406). HIC placed higher priority on treatment experience (mean rank:3.0�1.6vs3.7�1.4, p=0.002) and less on costs to the health-system (mean rank:5.6�1.2vs5.2�1.3, p=0.036) compared to LMIC.
Conclusion
Providers in HIC and LMIC prioritized the emotional and functional well-being of patients. However, those in LMIC placed a higher emphasis on the costs of care while providers from HIC prioritized treatment experience more than their counterparts. Integrating divergent perspectives is crucial for creating frameworks to deliver value-based cancer care globally.

Figure: Comparative analysis of provider perspectives regarding various healthcare priorities for cancer patient care in high income countries (HIC) and low-middle income countries (LMIC).

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