The Cost-Effectiveness Evaluation of the Intraoperative Additional Photodynamic Therapy for the Treatment of Newly Diagnosed Glioblastoma

J. Akimoto, T. Takura
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Abstract

The aim of the present study was to perform a comparative evaluation of the cost-effectiveness of health insurance-approved additional treatments to the standard Stupp regimen for newly diagnosed glioblastoma. According to the clinical symptoms and disease progression of patients with newly diagnosed glioblastoma, a Markov model was constructed to estimate the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Utility parameters were obtained from the data of published phase II or III clinical studies. Additional intraoperative treatment using carmustine wafers and photodynamic therapy (PDT) increased overall costs by 1,035,000 yen and 1,212,290 yen, with a gain in 0.221 and 0.552 QALYs, resulting in ICERs of 4,683,258 yen/QALY and 2,196,178 yen/QALY, respectively. Furthermore, additional postoperative adjuvant treatment using Bevacizumab and Tumor-treating field increased overall costs by 4,719,942 yen and 9,000,000 yen, with a gain in 0.14 and 0.257 QALYs, resulting in ICERs of 33,713,971 yen/QALY and 35,019,455 yen/QALY, respectively. These data suggested that the additional intraoperative PDT was the most cost-effective treatment for patients with newly diagnosed glioblastoma in the context of an ICER of 5,000,000 yen/QALY willingness-to-pay threshold. The main limitation of this study was that the additional costs required for the adverse events that may occur as a result of these treatments were not evaluated, and these should be evaluated in the future using real-world diagnosis procedure combination (DPC) data. In summary, we showed that additional intraoperative PDT is an extremely low-cost and high-quality treatment option for the patients with newly diagnosed glioblastoma, using medico-economical evaluation.
术中附加光动力治疗新诊断的胶质母细胞瘤的成本-效果评价
本研究的目的是对新诊断的胶质母细胞瘤的标准Stupp方案的医疗保险批准的额外治疗的成本效益进行比较评估。根据新诊断的胶质母细胞瘤患者的临床症状和疾病进展,构建马尔可夫模型估计质量调整生命年(QALYs)和增量成本-效果比(ICERs)。效用参数是从已发表的II期或III期临床研究数据中获得的。术中使用卡莫司定晶片和光动力疗法(PDT)的额外治疗增加了1,035,000日元和1,212,290日元的总成本,增加了0.221和0.552个QALY,导致ICERs分别为4,683,258日元/QALY和2,196,178日元/QALY。此外,使用贝伐单抗和肿瘤治疗领域的额外术后辅助治疗增加了4,719,942日元和9,000,000日元的总成本,增加了0.14和0.257 QALY,导致ICERs分别为33,713,971日元/QALY和35,019,455日元/QALY。这些数据表明,在ICER为500万日元/QALY支付意愿阈值的情况下,术中额外的PDT是新诊断的胶质母细胞瘤患者最具成本效益的治疗方法。本研究的主要局限性是,由于这些治疗可能发生的不良事件所需的额外费用没有得到评估,这些应在未来使用实际诊断程序组合(DPC)数据进行评估。总之,我们通过医学经济评估表明,术中额外的PDT对于新诊断的胶质母细胞瘤患者是一种极低成本和高质量的治疗选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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