A Review of the Economic Burden of Glioblastoma and the Cost Effectiveness of Pharmacologic Treatments
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Grade IV glioma (glioblastoma) is one of the most common brain/central nervous system cancers. In 2005, the standard of care for adjuvant treatment was significantly changed with the approval of temozolomide. Carmustine wafers have also gained some popularity. Phase III trials are currently evaluating bevacizumab in conjunction with the standard temozolomide regimen. Despite these recent advances in pharmacotherapy, roughly two-thirds of patients do not survive longer than 2 years after diagnosis. Meanwhile, the costs of treatment are substantial. The goal of this study is to review the clinical, cost-of-illness, and cost-effectiveness literature relevant to treating glioblastoma. Estimates of the economic burden of glioblastoma within different healthcare systems were converted to 2013 US dollars. Temozolomide has demonstrated a 2.5-month increase in overall survival and a 1.9-month increase in progression-free survival, relative to radiotherapy alone. Carmustine wafers have also been shown to increase overall survival by 2.3 months, compared with placebo wafers. Cost-effectiveness studies of temozolomide have produced incremental cost-effectiveness ratios, adjusted to 2013 US dollars, with a range from US$73,586 per quality-adjusted life-year (QALY) (UK National Health Service perspective) to US$105,234 per QALY (US societal perspective). More research is needed to quantify the full societal burden of illness.
KeywordsOverall Survival Bevacizumab Temozolomide Probabilistic Sensitivity Analysis Glioblastoma Patient
Statement on financial disclosure/conflict of interest
Dr. Messali, Mr. Villacorta, and Dr. Hay have no conflicts of interest to declare.
Dr. Andrew Messali, Mr. Reginald Villacorta, and Dr. Joel Hay had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Messali, Villacorta, Hay. Acquisition of data: Messali, Villacorta. Analysis and interpretation of data: Messali, Villacorta, Hay. Drafting of the manuscript: Messali, Villacorta, Hay. Critical revision of the manuscript for important intellectual content: Messali, Villacorta, Hay. Final guarantor of content: Messali.
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