Subgroup Economic Analysis for Glioblastoma in a Health Resource-Limited Setting

Abstract

BackgroundThe aim of this research was to evaluate the economic outcomes of radiotherapy (RT), temozolomide (TMZ) and nitrosourea (NT) strategies for glioblastoma patients with different prognostic factors.Methodology/Principal FindingsA Markov model was developed to track monthly patient transitions. Transition probabilities and utilities were derived primarily from published reports. Costs were estimated from the perspective of the Chinese healthcare system. The survival data with different prognostic factors were simulated using Weibull survival models. Costs over a 5-year period and quality-adjusted life years (QALYs) were estimated. Probabilistic sensitivity and one-way analyses were performed. The baseline analysis in the overall cohort showed that the TMZ strategy increased the cost and QALY relative to the RT strategy by $25,328.4 and 0.29, respectively; and the TMZ strategy increased the cost and QALY relative to the NT strategy by $23,906.5 and 0.25, respectively. Therefore, the incremental cost effectiveness ratio (ICER) per additional QALY of the TMZ strategy, relative to the RT strategy and the NT strategy, amounts to $87,940.6 and $94,968.3, respectively. Subgroups with more favorable prognostic factors achieved more health benefits with improved ICERs. Probabilistic sensitivity analyses confirmed that the TMZ strategy was not cost-effective. In general, the results were most sensitive to the cost of TMZ, which indicates that better outcomes could be achieved by decreasing the cost of TMZ.Conclusions/SignificanceIn health resource-limited settings, TMZ is not a cost-effective option for glioblastoma patients. Selecting patients with more favorable prognostic factors increases the likelihood of cost-effectiveness.

Management of glioblastoma: comparison of clinical practices and cost-effectiveness in two cohorts of patients (2008 versus 2004) diagnosed in a French university hospital

“…Very few economic studies on cost‐effectiveness of temozolomide for GBM patients are available . None is published about bevacizumab's economic impact.…”

Cost-effectiveness of preoperative motor mapping with navigated transcranial magnetic brain stimulation in patients with high-grade glioma

“…Utilities for each stage of treatment were extracted from the Global Burden of Disease Study (GBD 1990), 18 and from previously published literature 8,10,19,25 (Table 1). A discount rate of 3% was applied to health outcomes, as recommended by the WHO CHOICE (CHOosing Interventions that are Cost-Effective) guidelines.…”

“…The specific values and their standard deviations, as well as the assigned distributions, were obtained from previously published literature and are described in Table 5. 9,10,13,25…”

Clinical Practice Of Chemotherapy With Temozolomide In China

“…However, the substantial cost of TMZ restricts its widespread use, especially in health resource-limited regions in China. Wu conducted an economic analysis to evaluate the cost-effectiveness of TMZ in China [7]. The baseline analysis in the overall cohort showed that the TMZ strategy increased the cost and quality-adjusted life years (QALY) relative to the RT strategy by $25,328.4 and 0.29, respectively; and the TMZ strategy increased the cost and QALY relative to the other chemotherapy drugs such as nitrosourea (NT) strategy by $23,906.5 and 0.25, respectively.…”