A Pilot Cost-Effectiveness Analysis of Treatments in Newly Diagnosed High-Grade Gliomas

Esteves, Susana; Alves, Marta; Castel-Branco, Marta; Stummer, Walter

doi:10.1227/neu.0000000000000673

Cited by 36 publications

(27 citation statements)

References 28 publications

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“…Glioma cells convert 5-ALA to protoporphyrin IX (PPIX), which emits an intense red fluorescence signal under blue illumination. The approach has been employed in fluorescence guided resection of malignant gliomas or benign tumors such as ependymomas or meningiomas in adults 14,15 and children. 16,17 A large number of fluorescent camera implementations have been developed to capture fluorescence images from tissue during surgery or endoscopy.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive phantom for interventional fluorescence molecular imaging

et al. 2016

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Fluorescence imaging has been considered for over a half-century as a modality that could assist surgical guidance and visualization. The administration of fluorescent molecules with sensitivity to disease biomarkers and their imaging using a fluorescence camera can outline pathophysiological parameters of tissue invisible to the human eye during operation. The advent of fluorescent agents that target specific cellular responses and molecular pathways of disease has facilitated the intraoperative identification of cancer with improved sensitivity and specificity over nonspecific fluorescent dyes that only outline the vascular system and enhanced permeability effects. With these new abilities come unique requirements for developing phantoms to calibrate imaging systems and algorithms. We briefly review herein progress with fluorescence phantoms employed to validate fluorescence imaging systems and results. We identify current limitations and discuss the level of phantom complexity that may be required for developing a universal strategy for fluorescence imaging calibration. Finally, we present a phantom design that could be used as a tool for interlaboratory system performance evaluation.

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Section: Introductionmentioning

confidence: 99%

Comprehensive phantom for interventional fluorescence molecular imaging

et al. 2016

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“…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.…”

Section: Patientsmentioning

confidence: 99%

“…Published articles have analyzed the economic benefit of 5-ALA for intraoperative tumor resection and the financial outcome of carmustine implants as well as intraoperative neurophysiological monitoring. 8,10,11,21 To our knowledge, no study has been conducted on the economic evaluation of nTMS for preoperative motor mapping. Thus, the aim of this study is to estimate the financial burden of disease and the costeffectiveness of nTMS for HGG patients.…”

mentioning

confidence: 99%

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

Butenschön¹,

Ille²,

Sollmann³

et al. 2018

Neurosurgical Focus

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OBJECTIVENavigated transcranial magnetic stimulation (nTMS) is used to identify the motor cortex prior to surgery. Yet, there has, until now, been no published evidence on the economic impact of nTMS. This study aims to analyze the cost-effectiveness of nTMS, evaluating the incremental costs of nTMS motor mapping per additional quality-adjusted life year (QALY). By doing so, this study also provides a model allowing for future analysis of general cost-effectiveness of new neuro-oncological treatment options.METHODSThe authors used a microsimulation model based on their cohort population sampled for 1000 patients over the time horizon of 2 years. A health care provider perspective was used to assemble direct costs of total treatment. Transition probabilities and health utilities were based on published literature. Effects were stated in QALYs and established for health state subgroups.RESULTSIn all scenarios, preoperative mapping was considered cost-effective with a willingness-to-pay threshold < 3*per capita GDP (gross domestic product). The incremental cost-effectiveness ratio (ICER) of nTMS versus no nTMS was 45,086 Euros/QALY. Sensitivity analyses showed robust results with a high impact of total treatment costs and utility of progression-free survival. Comparing the incremental costs caused by nTMS implementation only, the ICER decreased to 1967 Euros/QALY.CONCLUSIONSMotor mapping prior to surgery provides a cost-effective tool to improve the clinical outcome and overall survival of high-grade glioma patients in a resource-limited setting. Moreover, the model used in this study can be used in the future to analyze new treatment options in neuro-oncology in terms of their general cost-effectiveness.

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“…Two recent analyses have demonstrated remarkably similar costs (approximately 9000 Euros) per quality-adjusted life-year in patients with HGG who undergo 5-ALA-assisted surgery versus conventional surgery. 74,75 Although this value is below the national thresholds for each study's respective nation, the derivation of utility values from patients enrolled in the studies of interest would increase the validity of the analyses. Furthermore, simply relying on thresholds for determining the acceptability of a new intervention can lead to ever-increasing health care costs.…”

Section: Implications For Researchmentioning

confidence: 99%

The role of 5‐aminolevulinic acid in enhancing surgery for high‐grade glioma, its current boundaries, and future perspectives: A systematic review

Mansouri

Mansouri²,

Hachem

et al. 2016

Cancer

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5-Aminolevulinic acid (5-ALA) has been approved as an intraoperative adjunct in glioma surgery in Europe, but not North America. A systematic review was conducted to assess the evidence regarding 5-ALA as a surgical adjunct. The MEDLINE, EMBASE, and CEN-TRAL databases were searched, using terms relevant to "5-ALA" and "high-grade gliomas." Included studies were based on adults aged 18 years who underwent surgical resection/biopsy. No language or date limitations were used. Forty-three studies (1830 patients) were identified. Thirty-six were coordinated by European countries, 2 were in the United States, and none were in Canada. One was randomized, 28 were prospective, and 14 were retrospective. Twenty-six studies assessed the utility of 5-ALA as a diagnostic tool, 24 assessed its influence on the extent of resection (EOR), 9 assessed survival, and 22 reported adverse events. 5-ALA had high sensitivity and positive predictive value, whereas its specificity increased with additional adjuncts. The EOR increased with 5-ALA, but only progression-free survival was significantly influenced. Reporting of adverse events was not systematic. The use of 5-ALA improved tumor visualization and thus enabled a greater EOR and perhaps increased survival. However, additional adjuncts may be necessary for maximizing the specificity of resection and patient safety. Additional parameters, such as patient quality of life and health economic analyses, would be informative. Thus, additional systematic collection of prospective evidence may be necessary for the global incorporation of this potentially valuable surgical adjunct into routine practice. Cancer 2016;122:2469-78.

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A Pilot Cost-Effectiveness Analysis of Treatments in Newly Diagnosed High-Grade Gliomas

Cited by 36 publications

References 28 publications

Comprehensive phantom for interventional fluorescence molecular imaging

Comprehensive phantom for interventional fluorescence molecular imaging

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

The role of 5‐aminolevulinic acid in enhancing surgery for high‐grade glioma, its current boundaries, and future perspectives: A systematic review

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