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