Carmustine Implants for the Treatment of Newly Diagnosed High-Grade Gliomas
Carmustine Implants for the Treatment of Newly Diagnosed High-Grade Gliomas
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卡莫司汀植入物治疗新诊断的高级别胶质瘤
DOI：
10.2165/00019053-200826010-00004
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发表时间：
2012
影响因子：
4.4
通讯作者：
M. Somerville
中科院分区：
文献类型：
--
作者：
Gabriel Rogers;R. Garside;S. Mealing;M. Pitt;Robert Anderson;M. Dyer;K. Stein;M. Somerville
背景高级别胶质瘤是一种侵袭性脑肿瘤，其有效治疗极具挑战性。颅内植入卡莫司汀晶片（BCNU-W），直接将化疗药物输送到受影响的区域，可能会延长该人群的生存期。然而，还没有注意到的经济影响，BCNU-W在此setting. Objectives探讨的成本效益的BCNU-W作为一种辅助手术，然后放疗，与手术加放疗单独相比。新诊断的，可操作的III级和IV级胶质瘤的平均年龄为55岁的人口被considered.MethodsA马尔可夫成本效用模型在Microsoft® Excel开发，采用英国NHS的角度来看。转移概率和成本数据（2004年数值）来自已发表的文献或专家意见。该模型纳入了从公众中获得的实用价值，反映了与高级别胶质瘤相关的生活质量。不确定性的影响进行了探讨，通过广泛的单向和概率敏感性analysis.ResultsSurgery与BCNU-W的植入，然后通过放疗成本£54 500每额外的QALY获得相比，手术加单独放疗。概率敏感性分析显示，在每个QALY 30 000英镑的支付意愿阈值下，BCNU-W被认为具有成本效益的概率<10%。虽然模型的输出是敏感的几个关键参数的变化，增量成本效益的干预仍然高于每QALY在所有analysis.ConclusionCompared新诊断的高级别胶质瘤的治疗与常规护理，BCNU-W是不太可能被认为是一个具有成本效益的医疗资源的使用时，在英格兰和威尔士普遍采用的标准判断。然而，这种疾病可怕的预后和替代疗法的缺乏是医疗保健专员在考虑收养决定时可能选择考虑的其他问题。
BackgroundHigh-grade gliomas are aggressive brain tumours that are extremely challenging to treat effectively. The intracranial implantation of carmustine wafers (BCNU-W), which delivers chemotherapy directly to the affected area, may prolong survival in this population. However, no attention has yet been paid to the economic implications of BCNU-W in this setting.ObjectiveTo investigate the cost effectiveness of BCNU-W as an adjunct to surgery followed by radiotherapy, compared with surgery plus radiotherapy alone. Newly diagnosed, operable grade III and IV gliomas in a population with a mean age of 55 years were considered.MethodsA Markov cost-utility model was developed in Microsoft® Excel, adopting a UK NHS perspective. Transition probabilities and cost data (year 2004 values) were obtained from published literature or expert opinion. The model incorporated utility values, obtained from members of the public, reflecting the quality of life associated with high-grade glioma. The effects of uncertainty were explored through extensive one-way and probabilistic sensitivity analysis.ResultsSurgery with the implantation of BCNU-W followed by radiotherapy costs £54 500 per additional QALY gained when compared with surgery plus radiotherapy alone. Probabilistic sensitivity analysis shows a <10% probability that BCNU-W would be considered cost effective at a willingness-to-pay threshold of £30 000 per QALY. Although model outputs were sensitive to alterations in several key parameters, the incremental cost effectiveness of the intervention remained above £30 000 per QALY in all analyses.ConclusionCompared with usual care for the treatment of newly diagnosed high-grade gliomas, BCNU-W is unlikely to be considered a cost-effective use of healthcare resources when judged by the standards commonly adopted in England and Wales. However, the dreadful prognosis of the condition and the paucity of alternative therapies are additional issues that healthcare commissioners may choose to take into account when considering an adoption decision.
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从乙烯-乙酸乙烯酯共聚物中控制释放 1,3-双(2-氯乙基)-1-亚硝基脲。
影响因子：
11.2
作者：
Yang,MB;Tamargo,RJ;Brem,H
通讯作者：
Brem,H
DOI：
10.1093/jnci/90.19.1473
发表时间：
1998-10-07
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Cairncross, JG;Ueki, K;Louis, DN
通讯作者：
Louis, DN
影响因子：
4.1
作者：
Barnholtz-Sloan, JS;Sloan, AE;Schwartz, AG
通讯作者：
Schwartz, AG
影响因子：
4.1
作者：
BREM, H;MAHALEY, S;KENEALY, JN
通讯作者：
KENEALY, JN