Management of glioblastoma: Comparison of clinical practices and cost-effectiveness in two cohorts of patients (2008 versus 2004) diagnosed in a French university hospital
Résumé
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. © 2014 John Wiley & Sons Ltd.
Mots clés
tumor recurrence
university hospital
Aged
Antibodies
Monoclonal
Humanized
Antineoplastic Agents
Chemoradiotherapy
Cohort Studies
Cost-Benefit Analysis
Dacarbazine
Drug Costs
Female
Follow-Up Studies
Glioblastoma
Health Care Costs
Hospital Costs
Hospitals
University
Humans
Male
Middle Aged
Neoplasm Recurrence
Local
Quality-Adjusted Life Years
Retrospective Studies
Survival Rate
Time Factors
Treatment Outcome
bevacizumab
carmustine
fotemustine
irinotecan
lomustine
nitrosourea
procarbazine
temozolomide
vincristine
antineoplastic agent
bevacizumab
monoclonal antibody
adult
Article
cancer adjuvant therapy
cancer combination chemotherapy
cancer patient
cancer radiotherapy
cancer recurrence
cancer survival
clinical practice
cohort analysis
comparative study
controlled study
cost effectiveness analysis
cost of illness
drug cost
drug implant
follow up
hospital care
human
major clinical study
multimodality cancer therapy
overall survival
retrospective study
analogs and derivatives
cost benefit analysis
economics
France
health care cost
hospital cost
pathology
procedures
quality adjusted life year
time