title: Management of glioblastoma: comparison of clinical practices and cost-effectiveness in two cohorts of patients (2008 versus 2004) diagnosed in a French university hospital.
abstract: OBJECTIVE
  Therapeutic options for the management of glioblastoma (GBM) have greatly evolved over the last decade with the emergence of new regimens combining radiotherapy plus temozolomide and the use of bevacizumab at recurrence. Our aim was to assess the clinical and economic impacts of those novel strategies in our center.
  
  
  METHODS
  A single-center retrospective chart review was conducted on patients newly diagnosed with a GBM over two periods (year 2004, group 1 or year 2008, group 2) with limitations to those eligible to radiotherapy after initial diagnosis. The type of medical management was described and compared, as well as overall survival and total costs from diagnosis to death or the last follow-up date. Cost analysis was performed under the French Sickness Fund perspective using tariffs from 2012.
  
  
  RESULTS
  One hundred twenty-two patients were selected (49 in group 1 and 73 in group 2) with similar baseline characteristics within the two groups. Patients from group 2 received more frequently temozolomide radiochemotherapy (71% vs. 39%, P < 0·05) as first-line treatment as well as bevacizumab regimen at recurrence (48% vs. 6%, P < 0·05); the median overall survival was increased between the two periods (respectively 17 vs. 10 months, P < 0·05). The mean total cost per patient was 54,388 € in group 1 and 71,148 € in group 2 (P < 0·05). Hospital care represented the largest expenditure (76% and 58% in groups 1 and 2 respectively) followed by chemotherapy drugs costs (11% and 30% respectively). The total cost difference between the two groups was explained by the increasing use of temozolomide and bevacizumab. The incremental cost-effectiveness ratio was estimated at 54,355 € per life-year gained.
  
  
  CONCLUSIONS
  As far as we know, this is the first study reporting the total cost of GBM management based on the French perspective, as well as the cost-effectiveness of clinical practices in term of cost per life-year gained. Those novel strategies have contributed to improve overall survival while inducing a substantial, but acceptable, increase of total costs.
authors.affiliation: Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Est, Lyon, France.
authors.forename: G
authors.initials: G
authors.lastname: Diebold
authors.forename: F
authors.initials: F
authors.lastname: Ducray
authors.forename: A-M
authors.initials: AM
authors.lastname: Henaine
authors.forename: D
authors.initials: D
authors.lastname: Frappaz
authors.forename: J
authors.initials: J
authors.lastname: Guyotat
authors.forename: S
authors.initials: S
authors.lastname: Cartalat-Carel
authors.forename: V
authors.initials: V
authors.lastname: Breant
authors.forename: A
authors.initials: A
authors.lastname: Fouquet
authors.forename: G
authors.initials: G
authors.lastname: Aulagner
authors.forename: J
authors.initials: J
authors.lastname: Honnorat
authors.forename: X
authors.initials: X
authors.lastname: Armoiry
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000068258:Bevacizumab; D059248:Chemoradiotherapy / Q000191:economics / Q000379:methods; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs; D005260:Female; D005500:Follow-Up Studies; D005602:France; D005909:Glioblastoma / Q000191:economics / Q000473:pathology / Q000628:therapy*; D017048:Health Care Costs; D017721:Hospital Costs; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D015996:Survival Rate; D000077204:Temozolomide; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068258:Bevacizumab; D003606:Dacarbazine; D000077204:Temozolomide
keywords: bevacizumab; clinical practice; cost-effectiveness analysis; costs; glioblastoma; medico-economic study; temozolomide