title: Can we afford to add chemotherapy to radiotherapy for glioblastoma multiforme? Cost-identification analysis of concomitant and adjuvant treatment with temozolomide until patient death.
abstract: BACKGROUND
  Adding temozolomide (TMZ) to standard radiotherapy as a first-line therapy for glioma may increase costs to a disproportionate degree compared with the resulting survival benefits.
  
  
  METHODS
  Forty-six consecutive patients (28 males and 18 females; median age, 52 years; age range, 24-70 years) received concomitant TMZ with radiotherapy for 6 weeks followed by adjuvant TMZ for 6 cycles, and they were followed until disease recurrence and then until death. The authors assessed the costs associated with the four phases of treatment from a hospital-centered perspective.
  
  
  RESULTS
  Treatment was discontinued early in 3 patients, 9 patients, and 15 patients during concomitant TMZ, before adjuvant TMZ, and during adjuvant TMZ, respectively. Karnofsky index values varied between 85% (at the beginning of treatment) and 76% (at the end of treatment). The nature of care after disease recurrence was diverse. Overall survival ranged from 1.4 months to 64.3 months (median, 15.8 months) and was better if surgical debulking could be carried out before treatment. Global costs amounted to Euros 39,092 +/- Euros 21,948 (concomitant TMZ, Euros 14,539 +/- Euros 4998; adjuvant TMZ, Euros 13,651 +/- Euros 4320; follow-up, Euros 6363 +/- Euros 6917; and recurrence, Euros 12,344 +/- Euros 18,327), with 53% of these costs being related to the acquisition of TMZ; this represented an eightfold increase in cost compared with radiotherapy alone.
  
  
  CONCLUSIONS
  TMZ may be an effective but costly adjuvant outpatient therapy for patients with glioblastoma multiforme. Definite cost-effectiveness/utility must be assessed in a randomized Phase III trial.
authors.affiliation: Health Technology Assessment Unit, University Hospital Center of Vaud, Lausanne, Switzerland. jean-blaise.wasserfallen@chuv.hospvd.ch
authors.forename: Jean-Blaise
authors.initials: JB
authors.lastname: Wasserfallen
authors.forename: Sandrine
authors.initials: S
authors.lastname: Ostermann
authors.forename: Alessia
authors.initials: A
authors.lastname: Pica
authors.forename: René-Olivier
authors.initials: RO
authors.lastname: Mirimanoff
authors.forename: Serge
authors.initials: S
authors.lastname: Leyvraz
authors.forename: Jean-Guy
authors.initials: JG
authors.lastname: Villemure
authors.forename: Roger
authors.initials: R
authors.lastname: Stupp
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000191:economics* / Q000627:therapeutic use*; D005060:Europe; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019853:O(6)-Methylguanine-DNA Methyltransferase / Q000235:genetics; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D019853:O(6)-Methylguanine-DNA Methyltransferase; D000077204:Temozolomide