title: High-grade astrocytomas: resource use, clinical outcomes, and cost of care.
abstract: OBJECTIVE
  To describe the clinical course, survival, resource use, and direct medical costs of care for patients with high-grade astrocytomas.
  
  
  METHODS
  All patients with grade 3 or 4 astrocytoma who resided in Olmsted County, Minnesota, or one of the six adjacent counties and had a tissue diagnosis first made between 1987 and 1992 were studied. Clinical characteristics, initial management, use of resources, clinical course, survival, and medical charges were analyzed.
  
  
  RESULTS
  Sixty-four patients, with a mean age of 62 years, were identified; 81% had glioblastoma multiforme. Approximately 60% underwent surgical resection, 80% had radiotherapy, and 50% had chemotherapy for initial management. After initial treatment (median duration, 116 days), approximately 75% of patients had a course with stable disease (median duration, 198 days). The overall median duration of survival was 323 days; lower grade and younger age were significantly associated with longer median survival-for example, 1,493 days for patients younger than 65 years with grade 3 astrocytomas and 205 days for patients 65 years old or older with grade 4 astrocytomas. The mean total direct medical charges were $67,887.
  
  
  CONCLUSIONS
  In most patients with high-grade astrocytomas, a substantial period elapsed before disease progressed. Although the overall median duration of survival was less than 1 year, younger patients, especially those with grade 3 astrocytomas, had a longer survival. The management of patients with high-grade astrocytomas uses substantial health-care resources.
authors.affiliation: Division of Area General Internal Medicine and Section of Clinical Epidemiology, Mayo Clinic Rochester, Minnesota 55905, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Silverstein
authors.forename: T L
authors.initials: TL
authors.lastname: Cascino
authors.forename: W S
authors.initials: WS
authors.lastname: Harmsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001254:Astrocytoma / Q000191:economics / Q000401:mortality / Q000628:therapy; D001932:Brain Neoplasms / Q000191:economics / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed