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Clinical Therapy Trials—Outcomes |
Health Technology Assessment Unit (J.B.W.), Multidisciplinary Oncology Centre (S.O., S.L., R.S.), Centre Hospitalier Universitaire Vaudois, University of Lausanne, CH-1011 Lausanne, Switzerland
1 Address correspondence to Jean-Blaise Wasserfallen, University Hospital (CHUV), Rue du Bugnon, 46, CH-1011 Lausanne, Switzerland (Jean-Blaise.Wasserfallen{at}chuv.hospvd.ch).
Abstract
Effectiveness and costs of care and treatment of recurrent malignant
gliomas are largely unknown. In this study, 49 patients (32 males, 17 females;
mean age, 49; age range, 23-79) were treated with temozolomide (TMZ) for
recurrent or progressive malignant gliomas after standard radiation therapy.
Cost assessment (payer's perspective) singled out treatment for first
recurrence and all costs of care until death. We computed personnel costs as
wages; drugs, imaging, and laboratory tests as prices; and hospitalizations as
day rates. Patients were administered a median of five TMZ cycles at
recurrence. Drug acquisition costs amounted to 
2206 per cycle (76% of
total costs). Seven patients showed no second recurrence (two are still
alive), 16 received no further chemotherapy and died after 3.9 months, and 26
received second-line chemotherapy. After the second progression, median
survival was 4.0 months (95% confidence interval, 1.8-6.1). Overall monthly
costs of care varied between 2450 and 3242 among the different
groups, and median cost-effectiveness and cost utility ranged from
28,817 to 38,450 and from 41,167 to 53,369 per life of
year and per quality-adjusted life-year gained, respectively. We conclude that
despite high TMZ drug acquisition costs, care of recurrent malignant gliomas
is comparable to other accepted therapies.
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