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Tumor treating fields and maintenance temozolomide for newly-diagnosed glioblastoma: a cost-effectiveness study.

Authors
  • Guzauskas, Gregory F1
  • Pollom, Erqi L2
  • Stieber, Volker W3
  • Wang, Bruce C M4
  • Garrison, Louis P Jr1
  • 1 Department of Pharmacy, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington , Seattle , WA , USA.
  • 2 Department of Radiation Oncology, Stanford University , Stanford , CA , USA.
  • 3 Department of Radiation Oncology, Novant Health Forsyth Medical Center , Winston-Salem , NC , USA.
  • 4 Elysia Group, LLC , New York , NY , USA.
Type
Published Article
Journal
Journal of medical economics
Publication Date
Oct 01, 2019
Volume
22
Issue
10
Pages
1006–1013
Identifiers
DOI: 10.1080/13696998.2019.1614933
PMID: 31050315
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Purpose: The EF-14 trial demonstrated that adding tumor treating fields (TTFields) to maintenance temozolomide (TMZ) significantly extends progression-free survival (PFS) and overall survival (OS) for newly-diagnosed glioblastoma (GBM) patients. This study assessed the cost-effectiveness of TTFields and TMZ for newly-diagnosed GBM from the US healthcare system perspective. Methods and materials: Outcomes for newly-diagnosed GBM patients were estimated over a lifetime horizon using an area under the curve model with three states: stable disease, progressive disease, or death. The survival model integrated the 5-year EF-14 trial results with long-term GBM epidemiology data and US background mortality rates. Adverse event rates were derived from the EF-14 trial data. Utility values to determine quality-adjusted life-years, adverse event costs, and supportive care costs were obtained from published literature. A 3% discount rate was applied to future costs and outcomes. One-way and probabilistic sensitivity analyses were performed to assess result uncertainty due to parameter variability. Results: Treatment with TTFields and TMZ was estimated to result in a mean increase in survival of 1.25 life years (95% credible range [CR] = 0.89-1.67) and 0.96 quality-adjusted life years (QALYs) (95% CR = 0.67-1.30) compared to treatment with TMZ alone. The incremental total cost was $188,637 (95% CR = $145,324-$225,330). The incremental cost-effectiveness ratio (ICER) was $150,452 per life year gained and $197,336 per QALY gained. The model was most sensitive to changes in the cost of TTFields treatment. Conclusions: Adding TTFields to maintenance TMZ resulted in a substantial increase in the estimated mean lifetime survival and quality-adjusted survival for newly-diagnosed GBM patients. Treatment with TTFields can be considered cost-effective within the reported range of willingness-to-pay thresholds in the US.

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