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Original article

Vol. 149 No. 4950 (2019)

Impact of treatment decision algorithms on treatment costs in recurrent glioblastoma: a health economic study

  • Cédric M. Panje
  • Paul M. Putora
  • Thomas Hundsberger
  • Andreas F. Hottinger
  • Ulrich Roelcke
  • Gianfranco Pesce
  • Evelyn Herrmann
  • Klazien Matter-Walstra
DOI
https://doi.org/10.4414/smw.2019.20153
Cite this as:
Swiss Med Wkly. 2019;149:w20153
Published
02.12.2019

Summary

AIMS

Recurrent glioblastoma (GBM) is a disease with poor prognosis. Although several therapeutic approaches such as chemotherapy, irradiation or surgery have been investigated, there is no established standard therapy. A recent survey among Swiss neuro-oncology centres has shown considerable controversy in the treatment recommendations for any specific scenario of recurrent GBM. In view of the cost differences of the available treatment alternatives, the aim of our study was assess the financial impact of different institutional therapeutic strategies for recurrent GBM in Switzerland.

METHODS

We created a decision analytic model for each of the eight centres participating in the initial study with a centre-specific treatment algorithm to evaluate the average treatment cost per patient. The probability of decision criteria was varied by univariate and probabilistic sensitivity analysis over a wide range to account for the high level of uncertainty. Treatment costs were calculated from the perspective of the Swiss healthcare payer.

RESULTS

Mean treatment costs per patient calculated on the basis of the institutional treatment algorithms ranged from CHF 13,748 to CHF 22,072 depending on the probability of individual decision criteria. The most influential decision factors for the mean treatment costs were the probability of fit patients and the proportion of patients with resectable tumour recurrences. There was a significant correlation between the complexity of treatment algorithms in a centre and the resulting mean treatment costs.

CONCLUSIONS

Institutional treatment algorithms can be used to estimate the average treatment costs per patient, which are, however, highly sensitive to probability changes of individual decision criteria. Our study demonstrates a high variability in treatment costs for recurrent GBM among eight Swiss neuro-oncology centres based on individual institutional treatment algorithms.

References

  1. Ostrom QT, Gittleman H, Truitt G, Boscia A, Kruchko C, Barnholtz-Sloan JS. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2011-2015. Neuro-oncol. 2018;20(suppl_4):iv1–86. doi:.https://doi.org/10.1093/neuonc/noy131
  2. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al.; European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987–96. doi:.https://doi.org/10.1056/NEJMoa043330
  3. Perry JR, Laperriere N, O’Callaghan CJ, Brandes AA, Menten J, Phillips C, et al.; Trial Investigators. Short-Course Radiation plus Temozolomide in Elderly Patients with Glioblastoma. N Engl J Med. 2017;376(11):1027–37. doi:.https://doi.org/10.1056/NEJMoa1611977
  4. Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016;131(6):803–20. doi:.https://doi.org/10.1007/s00401-016-1545-1
  5. Weller M, Cloughesy T, Perry JR, Wick W. Standards of care for treatment of recurrent glioblastoma--are we there yet? Neuro-oncol. 2013;15(1):4–27. doi:.https://doi.org/10.1093/neuonc/nos273
  6. Seystahl K, Wick W, Weller M. Therapeutic options in recurrent glioblastoma--An update. Crit Rev Oncol Hematol. 2016;99:389–408. doi:.https://doi.org/10.1016/j.critrevonc.2016.01.018
  7. Birk HS, Han SJ, Butowski NA. Treatment options for recurrent high-grade gliomas. CNS Oncol. 2017;6(1):61–70. doi:.https://doi.org/10.2217/cns-2016-0013
  8. Weller M, Tabatabai G, Kästner B, Felsberg J, Steinbach JP, Wick A, et al.; DIRECTOR Study Group. MGMT Promoter Methylation Is a Strong Prognostic Biomarker for Benefit from Dose-Intensified Temozolomide Rechallenge in Progressive Glioblastoma: The DIRECTOR Trial. Clin Cancer Res. 2015;21(9):2057–64. doi:.https://doi.org/10.1158/1078-0432.CCR-14-2737
  9. Brada M, Stenning S, Gabe R, Thompson LC, Levy D, Rampling R, et al. Temozolomide versus procarbazine, lomustine, and vincristine in recurrent high-grade glioma. J Clin Oncol. 2010;28(30):4601–8. doi:.https://doi.org/10.1200/JCO.2009.27.1932
  10. Taal W, Oosterkamp HM, Walenkamp AM, Dubbink HJ, Beerepoot LV, Hanse MC, et al. Single-agent bevacizumab or lomustine versus a combination of bevacizumab plus lomustine in patients with recurrent glioblastoma (BELOB trial): a randomised controlled phase 2 trial. Lancet Oncol. 2014;15(9):943–53. doi:.https://doi.org/10.1016/S1470-2045(14)70314-6
  11. Wick W, Gorlia T, Bendszus M, Taphoorn M, Sahm F, Harting I, et al. Lomustine and Bevacizumab in Progressive Glioblastoma. N Engl J Med. 2017;377(20):1954–63. doi:.https://doi.org/10.1056/NEJMoa1707358
  12. Robin AM, Lee I, Kalkanis SN. Reoperation for Recurrent Glioblastoma Multiforme. Neurosurg Clin N Am. 2017;28(3):407–28. doi:.https://doi.org/10.1016/j.nec.2017.02.007
  13. Howard SP, Krauze A, Chan MD, Tsien C, Tomé WA. The evolving role for re-irradiation in the management of recurrent grade 4 glioma. J Neurooncol. 2017;134(3):523–30. doi:.https://doi.org/10.1007/s11060-017-2392-1
  14. Suchorska B, Weller M, Tabatabai G, Senft C, Hau P, Sabel MC, et al. Complete resection of contrast-enhancing tumor volume is associated with improved survival in recurrent glioblastoma-results from the DIRECTOR trial. Neuro-oncol. 2016;18(4):549–56. doi:.https://doi.org/10.1093/neuonc/nov326
  15. Yong RL, Wu T, Mihatov N, Shen MJ, Brown MA, Zaghloul KA, et al. Residual tumor volume and patient survival following reoperation for recurrent glioblastoma. J Neurosurg. 2014;121(4):802–9. doi:.https://doi.org/10.3171/2014.6.JNS132038
  16. Gorlia T, Stupp R, Brandes AA, Rampling RR, Fumoleau P, Dittrich C, et al. New prognostic factors and calculators for outcome prediction in patients with recurrent glioblastoma: a pooled analysis of EORTC Brain Tumour Group phase I and II clinical trials. Eur J Cancer. 2012;48(8):1176–84. doi:.https://doi.org/10.1016/j.ejca.2012.02.004
  17. Hundsberger T, Brügge D, Putora PM, Weder P, Weber J, Plasswilm L. Re-irradiation with and without bevacizumab as salvage therapy for recurrent or progressive high-grade gliomas. J Neurooncol. 2013;112(1):133–9. doi:.https://doi.org/10.1007/s11060-013-1044-3
  18. Panje CM, et al. Treatment Options in Oncology. JCO Clinical Cancer Inform. 2018;(2):1–10.
  19. Hundsberger T, Hottinger AF, Roelcke U, Roth P, Migliorini D, Dietrich PY, et al. Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes. J Neurooncol. 2016;126(1):175–83. doi:.https://doi.org/10.1007/s11060-015-1957-0
  20. Putora PM, Panje CM, Papachristofilou A, Dal Pra A, Hundsberger T, Plasswilm L. Objective consensus from decision trees. Radiat Oncol. 2014;9(1):270. doi:.https://doi.org/10.1186/s13014-014-0270-y
  21. Messali A, Villacorta R, Hay JW. A review of the economic burden of glioblastoma and the cost effectiveness of pharmacologic treatments. Pharmacoeconomics. 2014;32(12):1201–12. doi:.https://doi.org/10.1007/s40273-014-0198-y
  22. Wasserfallen JB, Ostermann S, Leyvraz S, Stupp R. Cost of temozolomide therapy and global care for recurrent malignant gliomas followed until death. Neuro-oncol. 2005;7(2):189–95. doi:.https://doi.org/10.1215/S1152851704000687
  23. Henaine AM, Paubel N, Ducray F, Diebold G, Frappaz D, Guyotat J, et al. Current trends in the management of glioblastoma in a French University Hospital and associated direct costs. J Clin Pharm Ther. 2016;41(1):47–53. doi:.https://doi.org/10.1111/jcpt.12346
  24. Tarmed, Swiss National Tariff Catalogue. Available at: www.tarmed.ch [Accessed 23 July 2017].
  25. Swiss DRG. SwissDRG System. Available at: http://www.swissdrg.org/de. [Accessed 23July 2017].
  26. BundesamtfürGesundheit. Swiss Specialty List. 2019; Available from: www.listedesspecialites.ch [accessed on 22 Feb. 2019].
  27. Chang SM, Theodosopoulos P, Lamborn K, Malec M, Rabbitt J, Page M, et al. Temozolomide in the treatment of recurrent malignant glioma. Cancer. 2004;100(3):605–11. doi:.https://doi.org/10.1002/cncr.11949
  28. Panje CM, Glatzer M, Sirén C, Plasswilm L, Putora PM. Treatment Options in Oncology. JCO Clin Cancer Inform. 2018;1:1–10. doi:.https://doi.org/10.1200/CCI.18.00017
  29. Taylor D. The reality of economics for oncologists. Breast. 2017;33:183–90. doi:.https://doi.org/10.1016/j.breast.2017.03.014
  30. Cagney DN, Alexander BM. The cost and value of glioblastoma therapy. Expert Rev Anticancer Ther. 2017;17(8):657–9. doi:.https://doi.org/10.1080/14737140.2017.1351355
  31. Diebold G, Ducray F, Henaine AM, Frappaz D, Guyotat J, Cartalat-Carel S, et al. Management of glioblastoma: comparison of clinical practices and cost-effectiveness in two cohorts of patients (2008 versus 2004) diagnosed in a French university hospital. J Clin Pharm Ther. 2014;39(6):642–8. doi:.https://doi.org/10.1111/jcpt.12199
  32. Lamers LM, Stupp R, van den Bent MJ, Al MJ, Gorlia T, Wasserfallen JB, et al.; EORTC 26981/22981 NCI-C CE3 Intergroup Study. Cost-effectiveness of temozolomide for the treatment of newly diagnosed glioblastoma multiforme: a report from the EORTC 26981/22981 NCI-C CE3 Intergroup Study. Cancer. 2008;112(6):1337–44. doi:.https://doi.org/10.1002/cncr.23297
  33. Wasserfallen JB, Ostermann S, Pica A, Mirimanoff RO, Leyvraz S, Villemure JG, et al. Can we afford to add chemotherapy to radiotherapy for glioblastoma multiforme? Cost-identification analysis of concomitant and adjuvant treatment with temozolomide until patient death. Cancer. 2004;101(9):2098–105. doi:.https://doi.org/10.1002/cncr.20619
  34. Dinnes J, Cave C, Huang S, Major K, Milne R. The effectiveness and cost-effectiveness of temozolomide for the treatment of recurrent malignant glioma: a rapid and systematic review. Health Technol Assess. 2001;5(13):1–73. doi:.https://doi.org/10.3310/hta5130
  35. Mabasa VH, Taylor SC. Re-evaluation of the cost effectiveness of temozolomide for malignant gliomas in British Columbia. J Oncol Pharm Pract. 2006;12(2):105–11. doi:.https://doi.org/10.1177/1078155206069161
  36. Kovic B, Xie F. Economic Evaluation of Bevacizumab for the First-Line Treatment of Newly Diagnosed Glioblastoma Multiforme. J Clin Oncol. 2015;33(20):2296–302. doi:.https://doi.org/10.1200/JCO.2014.59.7245
  37. Chinot OL, Wick W, Mason W, Henriksson R, Saran F, Nishikawa R, et al. Bevacizumab plus radiotherapy-temozolomide for newly diagnosed glioblastoma. N Engl J Med. 2014;370(8):709–22. doi:.https://doi.org/10.1056/NEJMoa1308345
  38. Gilbert MR, Dignam JJ, Armstrong TS, Wefel JS, Blumenthal DT, Vogelbaum MA, et al. A randomized trial of bevacizumab for newly diagnosed glioblastoma. N Engl J Med. 2014;370(8):699–708. doi:.https://doi.org/10.1056/NEJMoa1308573
  39. Roth P, Gramatzki D, Weller M. Management of Elderly Patients with Glioblastoma. Curr Neurol Neurosci Rep. 2017;17(4):35. doi:.https://doi.org/10.1007/s11910-017-0740-3
  40. Park CK, Kim JH, Nam DH, Kim CY, Chung SB, Kim YH, et al. A practical scoring system to determine whether to proceed with surgical resection in recurrent glioblastoma. Neuro-oncol. 2013;15(8):1096–101. doi:.https://doi.org/10.1093/neuonc/not069
  41. Panje CM, Glatzer M, von Rappard J, Rothermundt C, Hundsberger T, Zumstein V, et al. Applied Swarm-based medicine: collecting decision trees for patterns of algorithms analysis. BMC Med Res Methodol. 2017;17(1):123. doi:.https://doi.org/10.1186/s12874-017-0400-y
  42. Tosoni A, Franceschi E, Poggi R, Brandes AA. Relapsed Glioblastoma: Treatment Strategies for Initial and Subsequent Recurrences. Curr Treat Options Oncol. 2016;17(9):49. doi:.https://doi.org/10.1007/s11864-016-0422-4
  43. Bernard-Arnoux F, Lamure M, Ducray F, Aulagner G, Honnorat J, Armoiry X. The cost-effectiveness of tumor-treating fields therapy in patients with newly diagnosed glioblastoma. Neuro-oncol. 2016;18(8):1129–36. doi:.https://doi.org/10.1093/neuonc/now102
  44. Garside R, Pitt M, Anderson R, Rogers G, Dyer M, Mealing S, et al. The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma: a systematic review and economic evaluation. Health Technol Assess. 2007;11(45):iii–iv, ix-221. doi:.https://doi.org/10.3310/hta11450

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