Tumor treating fields and maintenance temozolomide for newly-diagnosed glioblastoma: a cost-effectiveness study

Abstract

Purpose: The EF-14 trial demonstrated that adding tumor treating fields (TTFields) to maintenance temozolomide (TMZ) significantly extends progression-free survival (PFS) and overall survival (OS) for newly-diagnosed glioblastoma (GBM) patients. This study assessed the cost-effectiveness of TTFields and TMZ for newly-diagnosed GBM from the US healthcare system perspective. Methods and materials: Outcomes for newly-diagnosed GBM patients were estimated over a lifetime horizon using an area under the curve model with three states: stable disease, progressive disease, or death. The survival model integrated the 5-year EF-14 trial results with long-term GBM epidemiology data and US background mortality rates. Adverse event rates were derived from the EF-14 trial data. Utility values to determine quality-adjusted life-years, adverse event costs, and supportive care costs were obtained from published literature. A 3% discount rate was applied to future costs and outcomes. One-way and probabilistic sensitivity analyses were performed to assess result uncertainty due to parameter variability. Results: Treatment with TTFields and TMZ was estimated to result in a mean increase in survival of 1.25 life years (95% credible range [CR] ¼ 0.89-1.67) and 0.96 quality-adjusted life years (QALYs) (95% CR ¼ 0.67-1.30

Tumor Treating Fields in the Management of Patients with Malignant Gliomas

“…Currently, TTFields treatment for supratentorial ndGBM and rGBM is covered by several healthcare insurers [ 93 – 95 ]. Cost is comparable to most novel cancer therapies [ 96 ] and was considered to be cost-effective for ndGBM as adjuvant therapy with TMZ compared with TMZ alone, from the US healthcare system perspective, with an incremental cost-effectiveness ratio (ICER) of ~ $150,000 per life year gained (LYG) [ 97 ]. However, global healthcare systems vary, and TTFields were not considered cost-effective from the French healthcare system perspective, with an ICER of ~ 520,000€ per LYG [ 98 , 99 ].…”

Challenges and Perspectives of Standard Therapy and Drug Development in High-Grade Gliomas

“…Tumor-treating field (TTF) is an anti-mitotic electric field therapy that tampers with cell division and assembly of organelle via the delivery of low-intensity alternating electric field to GBM tumor [239]. Initial clinical studies in recurrent GBM patients (n = 10), shows that TTF prolonged the median time of disease progression (26.1 months), 6 months progression-free survival rates (50%) and median overall survival (>62 weeks) [240,241] TTF can enhance Tmz therapeutic efficacy by delaying the repair of damaged DNA in newly diagnosed or recurrent GBM [242][243][244][245]. TTF in combination with Tmz increases overall survival (about four months) and progression-free survival (approximately three months) with reported improvement in patients' quality of life and low incidence of adverse effects as opposed to Tmz only (Table 7) [242,246,247].…”

The Value of Tumor Treating Fields in Glioblastoma

“…In fact, the price of Optune is not affordable for all patients. For example, in the United States, the price of treatment without commercial insurance is $21000/person/month, $150368/person/year of life, $198032/person/quality adjusted life year 2,10) . A study evaluated the cost-effectiveness of TTFields and TMZ for newly diagnosed GBM from the perspective of the US healthcare system 10) .…”

“…For example, in the United States, the price of treatment without commercial insurance is $21000/person/month, $150368/person/year of life, $198032/person/quality adjusted life year 2,10) . A study evaluated the cost-effectiveness of TTFields and TMZ for newly diagnosed GBM from the perspective of the US healthcare system 10) . Treatment with TTFields and TMZ was expected to give rise to a mean increase in survival of 1.25 life years and 0.96 quality-adjusted life years (QALYs) compared to treatment with TMZ alone.…”