title: Current trends in the management of glioblastoma in a French University Hospital and associated direct costs.
abstract: Trends in the care of glioblastoma in actual practice settings are poorly described. In a previous pharmacoepidemiologic study, we highlighted changes in the management of patients with glioblastoma (GBM) newly diagnosed between 2004 and 2008. Our aim was to complete and to extend the previous report with a study of a cohort of patients diagnosed in 2011 to emphasize the trends in the pharmacotherapy of GBM over the last decade.
  
  
  METHODS
  A single-centre study was undertaken of three historic cohorts of GBM patients newly diagnosed during years 2004, 2008 and 2011 (corresponding to groups 1, 2 and 3, respectively) but limited to patients eligible for radiotherapy after initial diagnosis. The type of medical management was described and compared, as well as overall survival and total cost from diagnosis to death or the last follow-up date. Cost analysis was performed from the French sickness fund perspective using tariffs from 2014.
  
  
  RESULTS
  Two hundred and seventeen patients (49 in Group 1, 73 in Group 2, 95 in Group 3) were selected with similar baseline characteristics. Fluorescence-guided surgery using 5-ALA was increasingly used over the three periods. There was a strong trend towards broader use of temozolomide radiochemotherapy (39%, 73% and 83% of patients, respectively) as first-line treatment as well as bevacizumab regimen at recurrence (6%, 48% and 58% of patients, respectively). The increase in overall survival between Group 2 and Group 1 was confirmed for patients in Group 3 (17·5 months vs. 10 months in Group 1). The mean total cost per patient was 53368 € in Group 1, 70 201 € in Group 2 and 78355 € in Group 3. Hospital care represented the largest expenditure (75%, 59% and 60% in groups 1, 2 and 3, respectively) followed by chemotherapy drug costs (11%, 30% and 29%, respectively).
  
  
  CONCLUSIONS
  This is the first study to report on changes in the management of GBM in real-life practice. The ten-year study indicates an improvement in overall survival but also an increase in total cost of care. The data should be useful for informing the care of GBM patients in settings similar to ours.
authors.affiliation: Université de Lyon, Claude Bernard Lyon 1, Lyon, France.|UMR CNRS 5510 MATEIS, Lyon, France.
authors.forename: A M
authors.initials: AM
authors.lastname: Henaine
authors.affiliation: Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Est, Lyon, France.
authors.forename: N
authors.initials: N
authors.lastname: Paubel
authors.affiliation: NeuroOncology Department, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.|Neuroscience Research Center INSERM U1028/CNRS UMR 5292, University Claude Bernard Lyon 1, Lyon, France.
authors.forename: F
authors.initials: F
authors.lastname: Ducray
authors.affiliation: Pharmacy Department, Centre Hospitalier de Roanne, Roanne, France.
authors.forename: G
authors.initials: G
authors.lastname: Diebold
authors.affiliation: Department of Pediatric and Adult Neuro-Oncology, Centre Léon Bérard, Lyon, France.
authors.forename: D
authors.initials: D
authors.lastname: Frappaz
authors.affiliation: Neurosurgery Department, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Lyon, France.
authors.forename: J
authors.initials: J
authors.lastname: Guyotat
authors.affiliation: NeuroOncology Department, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.|Neuroscience Research Center INSERM U1028/CNRS UMR 5292, University Claude Bernard Lyon 1, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Cartalat-Carel
authors.affiliation: Université de Lyon, Claude Bernard Lyon 1, Lyon, France.|UMR CNRS 5510 MATEIS, Lyon, France.|Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Est, Lyon, France.
authors.forename: G
authors.initials: G
authors.lastname: Aulagner
authors.affiliation: Université de Lyon, Claude Bernard Lyon 1, Lyon, France.|UMR CNRS 5510 MATEIS, Lyon, France.
authors.forename: D
authors.initials: D
authors.lastname: Hartmann
authors.affiliation: NeuroOncology Department, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
authors.forename: J
authors.initials: J
authors.lastname: Honnorat
authors.affiliation: Université de Lyon, Claude Bernard Lyon 1, Lyon, France.|UMR CNRS 5510 MATEIS, Lyon, France.|Hospices Civils de Lyon, Délégation à la Recherche Clinique et à l'Innovation, Cellule Innovation, Lyon, France.
authors.forename: X
authors.initials: X
authors.lastname: Armoiry
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives; D016527:Drug Costs; D005260:Female; D005500:Follow-Up Studies; D005602:France; D005909:Glioblastoma / Q000188:drug therapy* / Q000191:economics / Q000628:therapy; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D015996:Survival Rate; D000077204:Temozolomide
chemical_list: D000970:Antineoplastic Agents; D000068258:Bevacizumab; D003606:Dacarbazine; D000077204:Temozolomide
keywords: bevacizumab; clinical practice; costs; glioblastoma; temozolomide