Cost-effectiveness of 5-aminolevulinic acid-induced fluorescence in malignant glioma surgery

Abstract

Objective: This study evaluates the cost-effectiveness of 5-aminolevulinic acid (5-ALA, Gliolan®) in patients undergoing surgery for malignant glioma, in standard clinical practice conditions in Spain.

Material and methods: Cost-effectiveness ratios were determined in terms of incremental cost per complete resection (CR) and incremental cost per additional quality-adjusted life year (QALY), based on data collected in the VISIONA observational study.

Results: Incremental cost with 5-ALA versus conventional surgery using white light only amounts to € 4550 per additional CR achieved and € 9021 per QALY gained. A sensitivity analysis shows these results to be robust.

Conclusion: Malignant glioma surgery guided by 5-ALA fluorescence entails a moderate increase in hospital costs compared to current surgical practice and can be considered a cost-effective innovation.

Keywords: 5-aminolevulinic acid; Cirugía guiada con fluorescencia; Cost-effectiveness; Coste-efectividad; Fluorescence-guided surgery; Glioblastoma; Glioma maligno; Malignant glioma; Ácido 5-aminolevulínico.