Patients’ willingness to accept adverse event and cost tradeoffs from oral nicotinamide for reduced risk of non-melanoma skin cancer

Abstract

Background

Non-immunosuppressed patients with a history of multiple non-melanoma skin cancers (NMSCs) taking oral nicotinamide supplementation experienced a 23% decrease in annual NMSC risk in a randomized clinical trial. Patient preferences for risks and costs associated with nicotinamide are unknown.

Objectives

To understand how patients prioritize NMSC reduction, infection risk, and cost.

Methods

A sample of adults with history of ≥2 NMSC within the past five years undergoing Mohs procedure completed a discrete-choice experiment comprising two hypothetical treatments—characterized by varying reductions in NMSC incidence, increased severe infection risk, and cost—and no treatment. The data were analyzed with random-parameters logit models.

Results

A total of 203 subjects (mean age 71.5 years, 65.5% males) participated. For a 23% annual reduction in NMSC incidence, a 26% [95% CI: 8%–45%] annual increase in severe infection risk and $8 [95% CI: $2–14] monthly cost was acceptable. Outcomes across analyzed subgroups (before vs. during COVID pandemic, site of interview, less vs. more prior NMSCs) were similar.

Conclusions

Patients were unwilling to accept high severe infection risks to obtain the reduction in NMSC incidence observed in a nicotinamide trial, suggesting that routinely recommending nicotinamide may run counter to some patients’ preferences.

Keywords:

• Non-melanoma skin cancer
• discrete choice
• maximum acceptable risk
• willingness to pay
• chemoprophylaxis
• nicotinamide

Acknowledgments

We are thankful to the patients who participated at the clinics involved and to Jheeyae Ahn who assisted in collecting surveys and to A. Brett Hauber for helpful discussions during the study design. Martin M. Okun is Consultant for AbbVie, Alumis, Azora Therapeutics, Bluefin Biomedicine, Boehringer Ingelheim, Incyte, Insmed, Novartis, Phoenicis, Regeneron, Vyne Therapeutics. No other authors have conflicts.

Author contributions

Marco Boeri: method (lead); data analysis (lead); writing-original draft (supporting); writing-review and editing (supporting). Maral K. Skelsey: data curation (supporting); writing-review and editing (supporting). James A. Schiro: data curation (supporting); writing-review and editing (supporting). Susan E. Dozier: data curation (supporting); writing-review and editing (supporting). Robert Glinert: data curation (supporting); writing-review and editing (supporting). Martin M. Okun: conceptualization (lead); methodology (supporting); data curation (lead); writing-original draft (supporting); writing-review and editing (supporting).

Disclosure statement

Martin M. Okun is Consultant for AbbVie, Alumis, Azora Therapeutics, Bluefin Biomedicine, Boehringer Ingelheim, Chemocentryx, Incyte, Insmed, Novartis, Phoenicis, Regeneron, Vyne Therapeutics. No other authors have conflicts.

Additional information

Funding

None.