Cost-effectiveness of the long-term use of temozolomide for treating newly diagnosed glioblastoma in Germany

Abstract

Concomitant radiochemotherapy followed by six cycles of temozolomide (= short term) is considered as standard therapy for adults with newly diagnosed glioblastoma. In contrast, open-end administration of temozolomide until progression (= long-term) is proposed by some authors as a viable alternative. We aimed to determine the cost-effectiveness of long-term temozolomide therapy for patients newly diagnosed with glioblastoma compared to standard therapy. A Markov model was constructed to compare medical costs and clinical outcomes for both therapy types over a time horizon of 60 months. Transition probabilities for standard therapy were calculated from randomized controlled trial data by Stupp et al. The data for long-term temozolomide therapy was collected by matching a cohort treated in the Department of Neurosurgery at Jena University Hospital. Health utilities were obtained from a previous cost utility study. The cost perspective was based on health insurance. The base case analysis showed a median overall survival of 17.1 months and a median progression-free survival of 7.4 months for patients in the long-term temozolomide therapy arm. The cost-effectiveness analysis using all base case parameters in a time-dependent Markov model resulted in an incremental effectiveness of 0.022 quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) was €351,909/QALY. Sensitivity analyses showed that parameters with the most influence on ICER were the health state utility of progression in both therapy arms. Although open-ended temozolomide therapy is very expensive, the ICER of this therapy is comparable to that of the standard temozolomide therapy for patients newly diagnosed with glioblastoma.

Prognostic Significance of Preoperative Albumin to Alkaline Phosphatase Ratio in Patients with Glioblastoma

“…The examinations and treatments of GBM are expensive and represent a significant economic burden on health care system all around the world 47 . Compare with liquid biopsy, molecular test, and advanced magnetic resonance imaging (MRI) examination, blood biomarkers such like AAPR, NLR, platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) are convenient, cheap, and time-saving.…”

Combination Chemoradiotherapy with Temozolomide, Vincristine, and Interferon-β Might Improve Outcomes Regardless of O6-Methyl-Guanine-DNA-Methyltransferase (MGMT) Promoter Methylation Status in Newly Glioblastoma

“…In actual clinical practice in Japan, 6 treatment cycles of TMZ as speci ed in the protocol reported by Stupp et al [1] is not su cient, and TMZ treatment is actually continued for longer in many cases. In the literature, one report has described administration of TMZ for 101 cycles [24], and another indicated that long-term treatment with TMZ until progression is more cost-effective than a treatment protocol that recommends completion of TMZ treatment after 6 cycles [25]. Many publications have discussed the e cacy of long-term treatment [24,[26][27][28][29][30][31][32][33].…”

Combination chemoradiotherapy with temozolomide, vincristine, and interferon-β might improve outcomes regardless of O6-methyl-guanine-DNA-methyltransferase (MGMT) promoter methylation status in newly glioblastoma

“…In actual clinical practice in Japan, 6 treatment cycles of TMZ as specified in the protocol reported by Stupp et al [1] is not sufficient, and TMZ treatment is actually continued for longer in many cases. In the literature, one report has described administration of TMZ for 101 cycles [31], and another indicated that long-term treatment with TMZ until progression is more cost-effective than a treatment protocol that recommends completion of TMZ treatment after 6 cycles [32]. Many publications have discussed the efficacy of long-term treatment [31,[33][34][35][36][37][38][39][40].…”