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. 2021 Jan:7:108-117.
doi: 10.1200/GO.20.00288.

Cost-Effectiveness of Temozolamide for Treatment of Glioblastoma Multiforme in India

Nidhi Gupta  1 , Shankar Prinja  2 , Vijay Patil  3 , Pankaj Bahuguna  2
Affiliations

Cost-Effectiveness of Temozolamide for Treatment of Glioblastoma Multiforme in India

Nidhi Gupta et al. JCO Glob Oncol. 2021 Jan.

Abstract

Purpose: Glioblastoma multiforme (GBM) has poor outcomes following surgery and radiation. Adjuvant temozolamide along with radiation therapy has been shown to improve survival. In this paper, we evaluate the cost-effectiveness of concomitant temozolamide with radiation and maintenance temozolamide for 6 months of treatment for GBM in India.

Materials and methods: We used a Markov model to evaluate the lifetime costs and consequences of treating GBM with radiation alone versus radiation with adjuvant temozolamide. The model was calibrated using the published evidence from European Organisation for Research and Treatment of Cancer-NCIC trial on progression-free survival and overall survival to estimate the life years (LYs) and quality-adjusted LYs (QALYs). Cost of treatment and management of complications were estimated using the data from the National Health System Cost Database and Indian studies. Future cost and consequences were discounted at 3%. Incremental cost per QALY gained with temozolamide was estimated to assess cost effectiveness.

Results: Temozolamide resulted in an increase of 0.59 (0.53-0.66) LY and 0.33 (0.29-0.40) QALY per person at an incremental cost of ₹75,120 in Indian national rupee (INR) (59,337-93,960). Overall, the use of temozolamide incurs an incremental cost of ₹212,020 INR (138,127-401,466) per QALY gained, which has a 4.7% probability to be cost-effective at 1-time per capita Gross Domestic Product (GDP) threshold. In case the current price of temozolamide could be decreased by 90%, the probability of its use for GBM being cost-effective increases to 80%.

Conclusion: Temozolamide is not cost-effective for treatment of patients with GBM in India. This evidence should be used while framing guidelines for treatment and price regulation.

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Conflict of interest statement

Nidhi Gupta

Employment: Grecian Multispeciality Hospital, Mohali, Punjab, India

No other potential conflicts of interest were reported.

Figures

FIG 1
FIG 1
Probability of temozolamide use being cost-effective at varying willingness-to-pay thresholds. INR, Indian national rupee.
FIG 2
FIG 2
Price sensitivity analysis for cost-effectiveness of temozolamide. INR, Indian national rupee.
See this image and copyright information in PMC

References

    1. Wen P, Kesari S: Malignant gliomas in adults. N Engl J Med 359:492-507, 2008 - PubMed
    1. Cabrera A, Kirkpatrick J, Fiveash J, et al. : Radiation therapy for glioblastoma: Executive summary of an American Society for radiation oncology evidence-based clinical practice guideline. Pract Radiat Oncol 6:217-225, 2016 - PubMed
    1. Fine H, Dear K, Loeffler J, et al. : Meta‐analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer 71:2585-2597, 1993 - PubMed
    1. Stupp R, Hegi M, Mason W, et al. : Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncology 10:459-466, 2009 - PubMed
    1. Stupp R, Mason W, Van Den Bent M, et al. : Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Eng J Med 352:987-996, 2005 - PubMed

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