Title :

Cost-effectiveness of tumor-treating fields added to maintenance temozolomide in patients with glioblastoma: an updated evaluation using a partitioned survival model

Author(s) :

Connock, M. [Auteur]
Auguste, Patrick [Auteur]
Évolution, Écologie et Paléontologie (Evo-Eco-Paleo) - UMR 8198 [Evo-Eco-Paléo (EEP)]
Dussart, C. [Auteur]
Parcours santé systémique [P2S]
Guyotat, J. [Auteur]
Centre Hospitalier Lyon Sud [CHU - HCL] [CHLS]
Armoiry, X. [Auteur]
Matériaux, ingénierie et science [Villeurbanne] [MATEIS]

Journal title :

Journal of Neuro-Oncology

Pages :

605-611

Publisher :

Springer Verlag

Publication date :

2019

ISSN :

0167-594X

English keyword(s) :

temozolomide
adult
Article
bootstrapping
cancer patient
cohort analysis
controlled study
cost benefit analysis
cost control
cost effectiveness analysis
economic aspect
electric field
glioblastoma
health care cost
health care system
human
incremental cost effectiveness ratio
Kaplan Meier method
life years gained
maintenance therapy
major clinical study
middle aged
overall survival
partitioned survival model
progression free survival
randomized controlled trial (topic)
statistical model
survival analysis
survival rate
survival time
tumor treatment field

HAL domain(s) :

Sciences de l'ingénieur [physics]/Matériaux

English abstract : [en]

Purpose: A first cost-effectiveness analysis has raised a strong concern regarding the cost of tumor treatment fields (TTF) added to maintenance temozolomide for patients with glioblastoma. This evaluation was based on ...
Show more >Purpose: A first cost-effectiveness analysis has raised a strong concern regarding the cost of tumor treatment fields (TTF) added to maintenance temozolomide for patients with glioblastoma. This evaluation was based on effectiveness outcomes from an interim analysis of the pivotal trial, moreover it used a “standard” Markov model. Our objective was to update the cost-effectiveness evaluation using the more flexible potential of the “partitioned survival” model design and using the latest effectiveness data. Methods: We developed the model with three mutually exclusive health states: stable disease, progressive disease, and dead. Good fit parametric models were developed for overall survival and progression free survival and these generated clinically plausible extrapolations beyond the observed data. We adopted the perspective of the French national health insurance and used a 20-year time horizon. Results were expressed as cost/life-years (LY) gained (LYG). Results: The base case model generated incremental benefit of 0.604 LY at a cost of €453,848 which, after 4% annual discounting of benefits and costs, yielded an incremental cost effectiveness ratio (ICER) of €510,273/LYG. Using sensitivity analyses and bootstrapping methods results were found to be relatively robust and were only sensitive to TTF device costs and the modelling of overall survival. To achieve an ICER below €100,000/LYG would require a reduction in TTF device cost of approximately 85%. Conclusions: Using a different type of model and updated survival outcomes, our results show TTF remains an intervention that is not cost-effective, which greatly restrains its diffusion to potentially eligible patients. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.Show less >

Language :

Anglais

Popular science :

Non

Comment :

cited By 0

Collections :

• Évolution, Écologie et Paléontologie (Evo Eco Paleo) - UMR 8198

Source :

Harvested from HAL