title: A review of the economic burden of glioblastoma and the cost effectiveness of pharmacologic treatments.
abstract: 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.
authors.affiliation: Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, 3335 S. Figueroa St., Unit A, University Park Campus, UGW-Unit A, Los Angeles, CA, 90089-7273, USA, messali@usc.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Messali
authors.forename: Reginald
authors.initials: R
authors.lastname: Villacorta
authors.forename: Joel W
authors.initials: JW
authors.lastname: Hay
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D002330:Carmustine / Q000191:economics / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D018572:Disease-Free Survival; D005909:Glioblastoma / Q000188:drug therapy* / Q000191:economics* / Q000532:radiotherapy; D017048:Health Care Costs; D006801:Humans; D019057:Quality-Adjusted Life Years; D000077204:Temozolomide
chemical_list: D000970:Antineoplastic Agents; D003606:Dacarbazine; D002330:Carmustine; D000077204:Temozolomide
references.citation: J Clin Oncol. 2009 Oct 1;27(28):4733-40
references.pmid: 19720927
references.citation: Br J Neurosurg. 1998 Apr;12(2):118-22
references.pmid: 11013662
references.citation: Pharmacoeconomics. 2005;23(8):803-15
references.pmid: 16097842
references.citation: N Z Med J. 2005 Dec 16;118(1227):U1774
references.pmid: 16372024
references.citation: PLoS One. 2012;7(4):e34588
references.pmid: 22511951
references.citation: Lancet Oncol. 2012 Sep;13(9):916-26
references.pmid: 22877848
references.citation: Neuro Oncol. 2009 Feb;11(1):69-79
references.pmid: 18772354
references.citation: Cancer. 2008 Mar 15;112(6):1337-44
references.pmid: 18213621
references.citation: JAMA. 2013 Nov 6;310(17):1842-50
references.pmid: 24193082
references.citation: Can J Neurol Sci. 2001 Feb;28(1):61-5
references.pmid: 11252298
references.citation: J Clin Oncol. 2007 Aug 1;25(22):3357-61
references.pmid: 17664483
references.citation: Neurology. 2004 Aug 10;63(3):535-7
references.pmid: 15304589
references.citation: Acta Neurochir (Wien). 2006 Mar;148(3):269-75; discussion 275
references.pmid: 16482400
references.citation: Lancet. 1995 Apr 22;345(8956):1008-12
references.pmid: 7723496
references.citation: N Engl J Med. 2005 Mar 10;352(10):987-96
references.pmid: 15758009
references.citation: J Clin Oncol. 2010 Apr 20;28(12):2051-7
references.pmid: 20308655
references.citation: Health Technol Assess. 2007 Nov;11(45):iii-iv, ix-221
references.pmid: 17999840
references.citation: Acta Neuropathol. 2007 Aug;114(2):97-109
references.pmid: 17618441
references.citation: J Neurol Neurosurg Psychiatry. 2000 Dec;69(6):792-8
references.pmid: 11080235
references.citation: Eur J Cancer. 2012 Sep;48(14):2192-202
references.pmid: 22608262
references.citation: Lancet Oncol. 2009 May;10(5):459-66
references.pmid: 19269895
references.citation: Neuro Oncol. 2013 Nov;15(11):1532-42
references.pmid: 23935155
references.citation: Cancer. 2004 Nov 1;101(9):2098-105
references.pmid: 15389472
references.citation: Neuro Oncol. 2013 Feb;15(2):242-50
references.pmid: 23243055
references.citation: Neuro Oncol. 2003 Apr;5(2):79-88
references.pmid: 12672279
references.citation: Neuro Oncol. 2012 Nov;14 Suppl 5:v1-49
references.pmid: 23095881
references.citation: Lancet. 2002 Mar 23;359(9311):1011-8
references.pmid: 11937180