title: A pilot cost-effectiveness analysis of treatments in newly diagnosed high-grade gliomas: the example of 5-aminolevulinic Acid compared with white-light surgery.
abstract: BACKGROUND
  High-grade gliomas are aggressive, incurable tumors characterized by extensive diffuse invasion of the normal brain parenchyma. Novel therapies at best prolong survival; their costs are formidable and benefit is marginal. Economic restrictions thus require knowledge of the cost-effectiveness of treatments. Here, we show the cost-effectiveness of enhanced resections in malignant glioma surgery using a well-characterized tool for intraoperative tumor visualization, 5-aminolevulinic acid (5-ALA).
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of 5-ALA fluorescence-guided neurosurgery compared with white-light surgery in adult patients with newly diagnosed high-grade glioma, adopting the perspective of the Portuguese National Health Service.
  
  
  METHODS
  We used a Markov model (cohort simulation). Transition probabilities were estimated with the use of data from 1 randomized clinical trial and 1 noninterventional prospective study. Utility values and resource use were obtained from published literature and expert opinion. Unit costs were taken from official Portuguese reimbursement lists (2012 values). The health outcomes considered were quality-adjusted life-years, life-years, and progression-free life-years. Extensive 1-way and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  The incremental cost-effectiveness ratios are below &OV0556;10 000 in all evaluated outcomes, being around &OV0556;9100 per quality-adjusted life-year gained, &OV0556;6700 per life-year gained, and &OV0556;8800 per progression-free life-year gained. The probability of 5-ALA fluorescence-guided surgery cost-effectiveness at a threshold of &OV0556;20000 is 96.0% for quality-adjusted life-year, 99.6% for life-year, and 98.8% for progression-free life-year.
  
  
  CONCLUSIONS
  5-ALA fluorescence-guided surgery appears to be cost-effective in newly diagnosed high-grade gliomas compared with white-light surgery. This example demonstrates cost-effectiveness analyses for malignant glioma surgery to be feasible on the basis of existing data.
authors.affiliation: *Clinical Research Unit, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal; ‡Epidemiology and Statistics Unit, Research Center of Centro Hospitalar de Lisboa Central, Hospital Dona Estefânia, Lisboa, Portugal; §Microbiology Department, Escola Superior de Hotelaria e Turismo do Estoril, Estoril, Portugal; ¶Department of Neurosurgery, University of Münster, Münster, Germany.
authors.forename: Susana
authors.initials: S
authors.lastname: Esteves
authors.forename: Marta
authors.initials: M
authors.lastname: Alves
authors.forename: Marta
authors.initials: M
authors.lastname: Castel-Branco
authors.forename: Walter
authors.initials: W
authors.lastname: Stummer
mesh_terms: D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000191:economics; D001932:Brain Neoplasms / Q000191:economics / Q000473:pathology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005260:Female; D005910:Glioma / Q000191:economics / Q000628:therapy*; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D060787:Neoplasm Grading; D019635:Neurosurgical Procedures / Q000191:economics* / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years
chemical_list: D000622:Aminolevulinic Acid