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Temozolomide for malignant gliomas in British Columbia: A population-based cost-effectiveness analysis

University of British Columbia, BC, Canada

SCM Taylor, PharmD

British Columbia Cancer Agency (BCCA) Provincial Pharmacy Program, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6

F Hu BscPharm, MBA

British Columbia Cancer Agency (BCCA) Provincial Pharmacy Program, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6

J Barnett, BscPharm, FCSHP

British Columbia Cancer Agency (BCCA) Provincial Pharmacy Program, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6

B Thiessen, MD, FRCP

Division of Medical Oncology, British Columbia Cancer Agency (BCCA), 600 West 10th Avenue, Vancouver, BC, V5Z 4E6 Canada

Study objectives. To evaluate the cost-effectiveness and outcomes achieved in patients with recurrent malignant glioma treated with temozolomide in British Columbia, as compared to previous lomustine use in the same patient population, and to temozolomide literature reports. Outcomes assessed included median overall survival, 6-month overall survival and 6-month progression free survival.

Methods. A retrospective analysis was conducted to identify patients who received single-agent temozolomide or lomustine during successive, prespecified time periods. Data was collected on survival, disease progression, duration of therapy, cost of drug, labour and supplies, and successive or prior chemotherapy.

Results. Six-month progression free survival (PFS) occurred in 52% and 42.9% of patients in the temozolomide and lomustine cohorts, respectively (P=0.44). Six-month overall survival and median overall survival (OS) were 72% and 40.86 weeks for temozolomide patients and 64.3% and 46.7 weeks for lomustine patients. These outcomes were not statistically different between the two treatment groups. Associated with these outcomes, temozolomide patients received a median of six cycles of drug treatment, with a median cost per patient of $11 660 (CAN). Alternatively, lomustine patients received a median of four cycles with a median cost per patient of $189 (CAN). In the cost-effectiveness analysis for median OS, temozolomide was not a cost-effective alternative, and for 6-month PFS, the incremental cost effectiveness ratio (ICER) of temozolomide was $1261 (CAN) for each additional percent of patients progression free at 6-months. Sensitivity analysis varying both median OS and 6-month PFS resulted in ICER’s of temozolomide ranging from $332 to $3277.

Conclusions. No significant differences in outcomes were observed between patients treated with single-agent lomustine or temozolomide. Temozolomide therapy has an incremental cost increase over lomustine of $11 471 per patient. It appears when only survival outcomes and direct treatment costs are considered, lomustine is a more cost-effective treatment strategy in the specific setting of recurrent malignant glioma.

Key Words: astrocytoma • cost-effectiveness • glioma • lomustine • temozolomide

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