Economics of Malignant Gliomas: A Critical Review

Abstract

Purpose: Approximately 18,500 persons are diagnosed with malignant glioma in the United States annually. Few studies have investigated the comprehensive economic costs. We reviewed the literature to examine costs to patients with malignant glioma and their families, payers, and society.Methods: A total of 18 fully extracted studies were included.Data were collected on direct and indirect costs, and cost estimates were converted to US dollars using the conversion rate calculated from the study's publication date, and updated to 2011 values after adjustment for inflation. A standardized data abstraction form was used. Data were extracted by one reviewer and checked by another.Results: Before approval of effective chemotherapeutic agents for malignant gliomas, estimated total direct medical costs in the United States for surgery and radiation therapy per patient ranged from $50,600 to $92,700. The addition of temozolomide (TMZ) and bevacizumab to glioblastoma treatment regimens has resulted in increased overall costs for glioma care. Although health care costs are now less front-loaded, they have increased over the course of illness. Analysis using a willingness-to-pay threshold of $50,000 per quality-adjusted life-year suggests that the benefits of TMZ fall on the edge of acceptable therapies. Furthermore, indirect medical costs, such as productivity losses, are not trivial. Conclusion:With increased chemotherapy use for malignant glioma, the paradigm for treatment and associated out-ofpocket and total medical costs continue to evolve. Larger outof-pocket costs may influence the choice of chemotherapeutic agents, the economic implications of which should be evaluated prospectively.

Current Trends and Healthcare Resource Usage in the Hospital Treatment of Primary Malignant Brain Tumor in Japan: A National Survey Using the Diagnostic Procedure Combination Database (J-ASPECT Study-Brain Tumor)

“…A recent publication showed that the total direct cost for surgery and RT ranged from 50,600 to 92,700 US dollars in the United States. 9) We found that the medical cost of patients undergoing both surgery and RT was 4,757,000 yen (46,184 dollars) in this study. Although the direct medical cost cannot be compared between countries with different health insurance systems, it seems clear that the direct medical expenditure for combined surgery and RT is within the same range in both countries.…”

“…6) Nevertheless, several studies demonstrated the cost-effectiveness of TMZ treatment in malignant brain tumor treatment. 7–9) In this context, there is no data as to how many primary brain tumor patients are treated in Japanese hospitals, and how often TMZ is administered overall and in single hospitals. Given that concomitant TMZ treatment after surgery is considered the standard treatment internationally for malignant glioma, the medical economics of TMZ usage should be evaluated in individual countries because the health insurance system is different in each country.…”

Glioblastoma Survival is Improving Despite Increasing Incidence Rates: A Nationwide Study between 2000 and 2013 in Finland

“…However, benefits of temozolomide in elderly should be weighed against treatment-related major side-effects, modest increase in survival time, amount of time spent in the hospital, and the high costs 35 . Furthermore, aggressively treating elderly glioblastoma patients may shift the attention away from end of life care, causing unnecessary suffering.…”

To a question of personalisation opportunities of application of chemotherapy brain tumors on the example of a temozolomid

“…на одного больного). В обзорной статье при анализе 18 публикаций [52] установлено, что при опухолях мозга операция и после-дующая ЛТ стоят от 50 600 до 92 700 долл., а добав-ление химиотерапии ТЗМ увеличивает эту стоимость еще на 50 000 долл. Несомненно, что в условиях ограниченных материальных ресурсов этот фактор следует учитывать при выборе метода лечения.…”