Economic implications of the modern treatment paradigm of glioblastoma: an analysis of global cost estimates and their utility for cost assessment

Figures & data

Table 1. Direct surgical costs for craniotomy for glioblastoma.

Cohort	Treatment	Country	Dx	Year	N	Cost
Mendez^16	RT + PCV	Canada	GBM	1996–1998	61	4,128
Latif	RT + PCV	U.K.	HGG	1989–1995	236	6,835
Esteves^17	5-ALA + RT + TMZ	Portugal	HGG	2012	MM	8,428
Rogers^18	RT only	U.K.	HGG	2004	MM	10,459
Garside^6	RT only	U.K.	HGG	2004	MM	11,699
Johannsen^19	RT only	Norway	GBM	1985–1999	58	13,890
Silverstein^11	mixed: RT only, RT + BCNU	U.S.	HGG	1987–1992	63	14,857
					Mean	10,042
					SD	3,847

Abbreviations. RT, Radiation therapy; TMZ, Temozolomide; GBM, Glioblastoma; HGG, High grade glioma; UK, United Kingdom; Dx, Diagnosis; PCV, Procarbazine/Lomustine/ and Vincristine; MM, Markov model; 5-ALA, 5-aminolevulinic acid; U.S., United States; BCNU, Carmustine.

Table 2. Imaging and other laboratory costs in glioblastoma care.

Cohort	Treatment	Country	Dx	Year	N	Cost
Henaine (group 1)^20	mixed: majority RT + TMZ	France	GBM	2004	43	1,135
Bernard-Arnoux^21	RT + TMZ	France	GBM	2014	MM	1,178
Mendez^16	RT + PCV	Canada	GBM	1996–1998	61	1,317
Henaine (group 3)^20	mixed: majority RT + TMZ	France	GBM	2011	95	1,457
Henaine (group 2)^20	mixed: majority RT + TMZ	France	GBM	2008	79	1,512
Bernard-Arnoux^21	RT + TMZ + TTF	France	GBM	2014	MM	1,548
Lamers^22	RT only	EU, Canada	GBM	2004	108	1,741
Latif^23	RT + PCV	U.K.	HGG	1989–1995	157	1,962
Lamers^22	RT + TMZ	EU, Canada	GBM	2004	110	2,746
Silverstein^11	mixed: RT only, RT + BCNU	U.S.	HGG	1987–1992	63	13,283
					Mean	2,788
					SD	3,717

Abbreviations. RT, Radiation therapy; TMZ, Temozolomide; GBM, Glioblastoma; HGG, High grade glioma; UK, United Kingdom; Dx, Diagnosis; PCV, Procarbazine/Lomustine/ and Vincristine; MM, Markov model; 5-ALA, 5-aminolevulinic acid; U.S., United States; EU, European Union; TTF, Tumor treating fields; BCNU, Carmustine.

Table 3. Postoperative radiotherapy costs for glioblastoma.

Cohort	Treatment	Country	Dx	Year	N	Cost
Wasserfalen^24	RT + TMZ	Switzerland	GBM	2004	46	2,949
Lamers^22	RT + TMZ	EU, Canada	GBM	2004	110	5,201
Lamers^22	RT only	EU, Canada	GBM	2004	108	5,211
Mendez^16	RT + PCV	Canada	GBM	1996–1998	61	5,371
Johannsen^19	RT only	Norway	GBM	1985–1999	58	5,508
Silverstein^11	mixed: RT only, RT + BCNU	U.S.	HGG	1987–1992	63	16,421
					Mean	6,777
					SD	4,820

Abbreviations. RT, Radiation therapy; TMZ, Temozolomide; GBM, Glioblastoma; HGG, High grade glioma; Dx, Diagnosis; PCV, Procarbazine/Lomustine/ and Vincristine; U.S., United States; EU, European Union; TTF, Tumor treating fields; BCNU, Carmustine.

Table 4. Combined cost estimates of surgery and radiation for glioblastoma.

Cohort	Country	Diagnosis	Study period	N	Time horizon	Overall survival (mo.)	Cost (USD)
Wu^10	China	GBM	2011	MM	5 years	12.1	7,932
Mendez^16	Canada	GBM	1996–1998	32	Until death	17.2	22,984
Lamers^22	EU, Canada	GBM	2004	108	2.5 years	12.1	25,540
Garside^6	U.K.	HGG	2004	MM	5 years	12.4	31,899
Johannsen^19	Norway	GBM	1985–1999	58	10 years	16.0	34,584
Latif^23	U.K.	HGG	1989–1995	157	–	–	35,127
Silverstein^11	U.S.	HGG	1987–1992	63	4 years	10.8	114,729
Ray^8	U.S.	MG	2006–2010	313	–.5 to. +1.5 years	19.5	149,180
					Mean	14.3	52,747
					SD	3.3	50,498

Abbreviations. GBM, Glioblastoma; HGG, High-grade glioma; UK, United Kingdom; U.S., United States; EU, European Union.

Table 5. Costs associated with complete modern treatment paradigm of glioblastoma including craniotomy, radiation, and chemotherapy.

Cohort	Country	Diagnosis	Study period	N	Time horizon	Overall survival (mo.)	Cost (USD)
Esteves^17	Portugal	HGG	2012	MM	Until death	20.2	36,801
Garside^6	U.K.	HGG	2004	MM	5 years	14.7	46,389
Kovic^7	Canada	GBM	2013	MM	2 years	16.8	14,110
Lamers^22	EU, Canada	GBM	2004	110	2.5 years	14.6	38,858
Wu^10	China	GBM	2011	MM	5 years	14.6	35,167
Ray^8	U.S.	HGG	2006 − 2010	841	–.5 to. +1.5 years	17.0	204,284
					Mean	16.3	62,602
					SD	2.2	70,243

Abbreviations. GBM, Glioblastoma; HGG, High-grade glioma; UK, United Kingdom; MM, Markov model; U.S., United States; EU, European Union.

Table 6. ICER of addition of chemotherapy to craniotomy and radiation alone.

Cohort	Country	Dx	Year	N	Time	Unit	Survival benefit (mo.)	Incremental cost (USD)	ICER
Garside^6	UK	HGG	2004	MM	5 years	QALY	2.6	14,565	67,060
Lamers^22	EU, Canada	GBM	2004	110 vs. 108	2.5 years	LYG	3.0	13,324	53,239
Wu^10	China	GBM	2011	MM	5 years	QALY	3.5	27,354	94,976
Messali^9	U.S.	GBM	2011	MM	5 years	QALY	0.9	8,599	110,553
Ray^8	U.S.	MG	2006–2010	841 vs. 313	–.5 to +1.5 years	–	–	55,104	–
Burton^25	U.S.	GBM	1997–2009	386 vs. 1818	Until death	–	–	37,679	–
						Mean	2.5	26,104	81,457
						SD	1.1	17,773	26,031

Abbreviations. GBM, Glioblastoma; HGG, High grade glioma; UK, United Kingdom; Dx, Diagnosis; U.S., United States; EU, European Union; LYG, Life-year gained; QALY, Quality adjusted life year; MM, Markov model.

Table 7. Costs associated with first recurrence of glioblastoma after surgical resection.

Cohort	1^st Therapy	2^nd Therapy	Country	Dx	Study period	N	Time	OS from 1^st recur (mo.)	Cost (USD)
Mabasa^26	RT + TMZ	Lomustine	Canada	Recurrent MG	2001–2003	25	3 yr	8.8	142
Mabasa^26	RT + TMZ	TMZ	Canada	Recurrent MG	2001–2003	41	3 yr	7.8	10,746
Ruiz-Sanchez^27	RT + TMZ	BVZ + Irinotecan	Spain	Recurrent GBM	2001 − 2011	36	Until death	17.6	27,094
Wasserfallen^28	RT + TMZ	TMZ	Swiss	Recurrent AA or GBM	2003	49	Until death	11.2	33,218
Martikainen^29	RT only	PCV	Finland	Recurrent GBM	1998–2000	MM	Until death	11.1	45,688
Martikainen^29	RT only	TMZ	Finland	Recurrent GBM	1998–2000	MM	Until death	12.1	47,763
							Mean	11.4	27,442
							SD	3.4	18,992

Abbreviations. RT, Radiation therapy; TMZ, Temozolomide; GBM, Glioblastoma; MG, Malignant glioma; AA, Anaplastic Astrocytoma; yr, Years; Dx, Diagnosis; PCV, Procarbazine/Lomustine/ and Vincristine; BVZ, Bevacizumab.

Table 8. ICER of adjunctive therapies for glioblastoma.

BCNU wafers, craniotomy, radiation vs. craniotomy and radiation
Cohort	Country	Dx	Year	N	Horizon	Unit	OS benefit (mo.)	Incremental cost (USD)	ICER
Garside^6	U.K.	HGG	2004	MM	5 years	QALY	1.5	12,342	101,917
5-ALA guided resection, radiation therapy, and chemotherapy vs. craniotomy, radiation, and chemotherapy
Cohort	Country	Dx	Year	N	Time	Unit	OS benefit (mo.)	Incremental cost (USD)	ICER
Esteves^17	Portugal	HGG	2012	MM	Until death	QALY	2	2,604	15,925
Slof^30	Spain	MG	2011	131 vs 120	2 years	QALY	1.3	1,566	13,983
						Mean	1.7	2,085	14,954
						SD	0.5	734	1,374
Tumor treating fields, craniotomy, chemotherapy, and radiation vs craniotomy, radiation, and chemotherapy; tumor treating fields and temozolomide vs. temozolomide alone
Cohort	Country	Dx	Year	N	Time	Unit	OS benefit (mo.)	Incremental cost (USD)	ICER
Bernard-Arnoux^21	France	GBM	2014	MM	Until death	LYG	3.7	237,409	763,406
Guzauskas^22	USA	GBM	2019	695	5 years	LYG	15	188,637	197,336
						Mean	9.35	213,023	480,371
						SD	15.65	24,836	283,035
Bevacizumab, craniotomy, radiation, and chemotherapy vs. craniotomy, radiation, and chemotherapy
Cohort	Country	Dx	Year	N	Time	Unit	OS benefit (mo.)	Incremental cost (USD)	ICER
Kovic^7	Canada	GBM	2014	MM	2 years	QALY	1.6	66,400	504,612

Abbreviations. GBM, Glioblastoma; MG, Malignant glioma; UK, United Kingdom; MM, Markov model; Dx, Diagnosis; EU, European Union; OS, Overall survival; USD, United States Dollars; ICER, Incremental cost effectiveness ratio; mo., Months; 5-ALA, 5-aminolevulinic acid; BCNU, Carmustine.

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