The cost-effectiveness of temozolomide in the adjuvant treatment of newly diagnosed glioblastoma in the United States
The cost-effectiveness of temozolomide in the adjuvant treatment of newly diagnosed glioblastoma in the United States
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DOI：
10.1093/neuonc/not096
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发表时间：
2013-11-01
期刊：
影响因子：
15.9
通讯作者：
Villacorta, Reginald
中科院分区：
文献类型：
--
作者：
Messali, Andrew;Hay, Joel W.;Villacorta, Reginald
这项工作的目的是确定替莫唑胺的成本效益相比，单独放疗辅助治疗新诊断的胶质母细胞瘤。替莫唑胺是唯一一种在随机临床试验中显示出显著生存获益的化疗药物。我们的分析建立在早期的工作，将照顾者的时间成本和通用替莫唑胺的可用性。这也是第一个适用于美国背景的分析，进行了系统的文献综述，以收集相关数据。转移概率是根据比较替莫唑胺加放疗与单纯放疗的随机对照试验数据计算的。直接成本根据马约诊所报告的费用计算。效用是从以前的成本效用分析中获得的。使用这些数据，一个马尔可夫模型，1个月的周期长度和5年的时间horizontal.Addition品牌Temodar和通用替莫唑胺的标准放疗方案与基础病例增量成本效益比分别为102 364美元和8875美元，每质量调整生命年。该模型是最敏感的无进展生存与使用唯一的radiotherapy.Both品牌和通用的基本情况下的估计是成本效益的意愿支付阈值为150 000美元每质量调整生命年。所有单向敏感性分析产生的增量成本效益比低于这一阈值。我们的结论是，无论是品牌Temodar和通用替莫唑胺是具有成本效益的治疗新诊断的胶质母细胞瘤在美国的背景下。然而，假设非专利产品产生同等的生活质量和生存效益，它将比品牌选择更具成本效益。
The objective of this work was to determine the cost-effectiveness of temozolomide compared with that of radiotherapy alone in the adjuvant treatment of newly diagnosed glioblastoma. Temozolomide is the only chemotherapeutic agent to have demonstrated a significant survival benefit in a randomized clinical trial. Our analysis builds on earlier work by incorporating caregiver time costs and generic temozolomide availability. It is also the first analysis applicable to the US context.A systematic literature review was conducted to collect relevant data. Transition probabilities were calculated from randomized controlled trial data comparing temozolomide plus radiotherapy with radiotherapy alone. Direct costs were calculated from charges reported by the Mayo Clinic. Utilities were obtained from a previous cost-utility analysis. Using these data, a Markov model with a 1-month cycle length and 5-year time horizon was constructed.The addition of brand Temodar and generic temozolomide to the standard radiotherapy regimen was associated with base-case incremental cost-effectiveness ratios of $102 364 and $8875, respectively, per quality-adjusted life-year. The model was most sensitive to the progression-free survival associated with the use of only radiotherapy.Both the brand and generic base-case estimates are cost-effective under a willingness-to-pay threshold of $150 000 per quality-adjusted life-year. All 1-way sensitivity analyses produced incremental cost-effectiveness ratios below this threshold. We conclude that both the brand Temodar and generic temozolomide are cost-effective treatments for newly diagnosed glioblastoma within the US context. However, assuming that the generic product produces equivalent quality of life and survival benefits, it would be significantly more cost-effective than the brand option.