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

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.