Wasserfallen Jean-Blaise, Ostermann Sandrine, Leyvraz Serge, Stupp Roger
Health Technology Assessment Unit, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon, CH-1011 Lausanne, Switzerland.
Neuro Oncol. 2005 Apr;7(2):189-95. doi: 10.1215/S1152851704000687.
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 euro 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 euro 2450 and euro 3242 among the different groups, and median cost-effectiveness and cost utility ranged from euro 28,817 to euro 38,450 and from euro 41,167 to euro 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.
复发性恶性胶质瘤的护理及治疗效果和成本在很大程度上尚不清楚。在本研究中，49例患者（32例男性，17例女性；平均年龄49岁；年龄范围23 - 79岁）在接受标准放疗后，使用替莫唑胺（TMZ）治疗复发性或进展性恶性胶质瘤。成本评估（从支付方角度）挑选出首次复发的治疗以及直至死亡的所有护理成本。我们将人员成本计算为工资；将药物、影像和实验室检查计算为价格；将住院计算为每日费用。患者复发时接受替莫唑胺周期数的中位数为5个。每个周期的药物购置成本为2206欧元（占总成本的76%）。7例患者未出现二次复发（2例仍存活），16例未接受进一步化疗，在3.9个月后死亡，26例接受了二线化疗。二次进展后，中位生存期为4.0个月（95%置信区间，1.8 - 6.1）。不同组之间每月的总体护理成本在2450欧元至3242欧元之间，中位成本效益和成本效用分别为每获得一年生命从28,817欧元至38,450欧元，以及每获得一个质量调整生命年从41,167欧元至53,369欧元。我们得出结论，尽管替莫唑胺的药物购置成本很高，但复发性恶性胶质瘤的护理与其他公认疗法相当。
