Management of glioblastoma: comparison of clinical practices and cost-effectiveness in two cohorts of patients (2008 versus 2004) diagnosed in a French university hospital

• Published in: Journal of clinical pharmacy and therapeutics Vol. 39; no. 6; pp. 642 - 648
• Main Authors: Diebold, G., Ducray, F., Henaine, A.-M., Frappaz, D., Guyotat, J., Cartalat-Carel, S., Breant, V., Fouquet, A., Aulagner, G., Honnorat, J., Armoiry, X.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01-12-2014; Blackwell; Hindawi Limited; Wiley
• Subjects: Aged; Antibodies, Monoclonal, Humanized - administration & dosage; Antibodies, Monoclonal, Humanized - economics; Antibodies, Monoclonal, Humanized - therapeutic use; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - economics; Antineoplastic Agents - therapeutic use; Bevacizumab; Biological and medical sciences; Chemoradiotherapy - economics; Chemoradiotherapy - methods; clinical practice; Cohort Studies; Cost-Benefit Analysis; cost-effectiveness analysis; costs; Dacarbazine - administration & dosage; Dacarbazine - analogs & derivatives; Dacarbazine - economics; Dacarbazine - therapeutic use; Drug Costs; Engineering Sciences; Female; Follow-Up Studies; France; glioblastoma; Glioblastoma - economics; Glioblastoma - pathology; Glioblastoma - therapy; Health Care Costs; Hospital Costs; Hospitals, University; Humans; Male; Materials; Medical sciences; medico-economic study; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Recurrence, Local; Neurology; Pharmacology. Drug treatments; Quality-Adjusted Life Years; Retrospective Studies; Survival Rate; temozolomide; Time Factors; Treatment Outcome; Tumors; Tumors of the nervous system. Phacomatoses; France; Europe; Antineoplastic agent; Costs; Glioblastoma; clinical practice; Monoclonal antibody; Bevacizumab; Malignant glioma; Cohort study; Diagnosis; Hospital; Antiangiogenic agent; Public health; Cost efficiency analysis; Human; Nervous system diseases; Malignant tumor; cost-effectiveness analysis; Immunomodulator; Alkylating agent; Clinical management; Vascular endothelium growth factor; University; Health economy; Central nervous system disease; Economic aspect; Temozolomide; Comparative study; Cancer; medico-economic study; temozolomide; costs; glioblastoma; bevacizumab; drug implant; Follow-Up Studies; hospital care; Humans; Middle Aged; major clinical study; Male; Chemoradiotherapy; Dacarbazine; Time Factors; overall survival; Monoclonal; Quality-Adjusted Life Years; drug cost; vincristine; cancer survival; Local; Survival Rate; analogs and derivatives; procarbazine; carmustine; Hospitals; cancer recurrence; adult; retrospective study; Cohort Studies; Drug Costs; Hospital Costs; hospital cost; comparative study; university hospital; pathology; cohort analysis; Article; Antibodies; cost benefit analysis; follow up; tumor recurrence; cancer radiotherapy; procedures; Female; multimodality cancer therapy; Retrospective Studies; France; quality adjusted life year; human; cancer adjuvant therapy; cancer combination chemotherapy; irinotecan; antineoplastic agent; Humanized; Antineoplastic Agents; Treatment Outcome; health care cost; lomustine; Health Care Costs; economics; fotemustine; controlled study; Cost-Benefit Analysis; cancer patient; Aged; Neoplasm Recurrence; nitrosourea; time; monoclonal antibody; cost effectiveness analysis; cost of illness
• ISSN: 0269-4727; 1365-2710
• DOI: 10.1111/jcpt.12199

Summary
What is known and 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.
What is new and conclusion
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.
This study presents the patterns of care of patients with GBM over two periods of treatment as well as the cost‐effectiveness of novel strategies.