title: Treatment Patterns, Survival, and Healthcare Costs of Patients with Malignant Gliomas in a Large US Commercially Insured Population.
abstract: BACKGROUND
  Glioblastoma multiforme is the most common malignant primary brain tumor in adults and is associated with poor survival rates. Symptoms often include headaches; nausea and vomiting; and progressive memory, personality, or neurologic deficits. The treatment remains a challenge, and despite the approval of multiple new therapies in the past decade, survival has not improved.
  
  
  OBJECTIVE
  To describe treatment patterns, survival, and healthcare costs of patients with incident glioblastoma in a large US population.
  
  
  METHODS
  For this population-based study, adult patients (aged ≥18 years) with incident malignant brain neoplasm who had undergone brain surgery between January 1, 2006, and December 31, 2010, were identified in the Truven Health Analytics MarketScan Research Databases. The patients were stratified into 4 cohorts based on the use of temozolomide and/or external beam radiation therapy within 90 days after brain surgery (ie, the index event). Treatment patterns, survival, and healthcare costs were assessed until patient death, disenrollment, or the end-of-study period.
  
  
  RESULTS
  A total of 2272 patients met the inclusion criteria; of these, 37% received temozolomide and radiation therapy, 13.8% received radiation alone, 3.9% received temozolomide alone, and 45.3% of patients received neither. The average patient age ranged from 55.3 years to 59.8 years across the study cohorts; between 29.8% and 44% of patients in each cohort were female. The duration of temozolomide use was similar between the temozolomide-only cohort and patients receiving temozolomide with external beam radiation; approximately 76% of patients received temozolomide at least 60 days, dropping to 48.1% and 23% at 180 days and 360 days of follow-up, respectively. The median survival was 456 days, ranging from 331 days in the temozolomide-only cohort to 529 days in the cohort that received neither temozolomide nor external beam radiation. The average total costs in the 6 months postindex were $106,896, from $79,099 for patients who received neither temozolomide nor radiation to $138,767 for those who received both therapies.
  
  
  CONCLUSIONS
  The survival patterns of patients with glioblastoma seen in this real-world study of current treatments in a clinical setting is similar to the survival rate reported in clinical trials. However, further cost-effectiveness and quality-of-life analyses will be critical to better understand the role of temozolomide therapy in this patient population, considering its considerable cost burden and potential negative impact on survival seen in this study.
authors.affiliation: Director, Oncology, AbbVie (formerly Abbott Laboratories), Abbott Park, IL.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Ray
authors.affiliation: Director, Outcomes Research, Truven Health Analytics, Cambridge, MA.
authors.forename: Machaon M
authors.initials: MM
authors.lastname: Bonafede
authors.affiliation: Assistant Professor of Oncology, Neuro-Oncology, University of Rochester Medical Center, Cambridge, Rochester, NY.
authors.forename: Nimish A
authors.initials: NA
authors.lastname: Mohile