title: Economics of Malignant Gliomas: A Critical Review.
abstract: Approximately 18,500 persons are diagnosed with malignant glioma in the United States annually. Few studies have investigated the comprehensive economic costs. We reviewed the literature to examine costs to patients with malignant glioma and their families, payers, and society.
  
  
  
  A total of 18 fully extracted studies were included. Data were collected on direct and indirect costs, and cost estimates were converted to US dollars using the conversion rate calculated from the study's publication date, and updated to 2011 values after adjustment for inflation. A standardized data abstraction form was used. Data were extracted by one reviewer and checked by another.
  
  
  
  Before approval of effective chemotherapeutic agents for malignant gliomas, estimated total direct medical costs in the United States for surgery and radiation therapy per patient ranged from $50,600 to $92,700. The addition of temozolomide (TMZ) and bevacizumab to glioblastoma treatment regimens has resulted in increased overall costs for glioma care. Although health care costs are now less front-loaded, they have increased over the course of illness. Analysis using a willingness-to-pay threshold of $50,000 per quality-adjusted life-year suggests that the benefits of TMZ fall on the edge of acceptable therapies. Furthermore, indirect medical costs, such as productivity losses, are not trivial.
  
  
  
  With increased chemotherapy use for malignant glioma, the paradigm for treatment and associated out-of-pocket and total medical costs continue to evolve. Larger out-of-pocket costs may influence the choice of chemotherapeutic agents, the economic implications of which should be evaluated prospectively.
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Raizer
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Fitzner
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Jacobs
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Dustin B
authors.initials: DB
authors.lastname: Liebling
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Thanh Ha
authors.initials: TH
authors.lastname: Luu
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Trifilio
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Sean A
authors.initials: SA
authors.lastname: Grimm
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Fisher
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Meraaj S
authors.initials: MS
authors.lastname: Haleem
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Ray
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Judith M
authors.initials: JM
authors.lastname: McKoy
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Rebecca
authors.initials: R
authors.lastname: DeBoer
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Katrina-Marie E
authors.initials: KM
authors.lastname: Tulas
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Deeb
authors.affiliation: Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center, Northwestern University; DePaul University; Rush Medical College; Northwestern Memorial Hospital; University of Chicago, Chicago; Midwestern University, Downers Grove; Northshore University Health Systems, Skokie Hospital, Skokie, IL; Yale School of Public Health, New Haven, CT; and South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions, South Carolina College of Pharmacy, the University of South Carolina, Columbia, SC j-mckoy@northwestern.edu.
authors.forename: June M
authors.initials: JM
authors.lastname: McKoy
mesh_terms: D001932:Brain Neoplasms / Q000191:economics* / Q000628:therapy; D002170:Canada; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D004358:Drug Therapy / Q000191:economics; D005060:Europe; D005910:Glioma / Q000191:economics* / Q000628:therapy; D006801:Humans; D011878:Radiotherapy / Q000191:economics; D000077204:Temozolomide; D014481:United States
chemical_list: D003606:Dacarbazine; D000077204:Temozolomide