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Re-evaluation of the cost effectiveness of temozolomide for malignant gliomas in British Columbia

Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, B.C., Canada

Suzanne CM Taylor, BSc (Pharm), PharmD, BCPS, FCSHP

Provincial Pharmacy Program, British Columbia Cancer Agency, Vancouver, B.C., Canada

Study objectives. To re-evaluate the cost effectiveness and median overall survival (OS) achieved in patients with recurrent malignant gliomas treated with temozolomide in British Columbia, as compared to previous lomustine use in the same patient population based on updated outcomes data. Results were also compared to temozolomide literature reports.

Methods. A retrospective medical record review was performed to identify patients who received single agent temozolomide or lomustine during successive, prespecified time periods. Data were collected on survival, duration of therapy, drug cost, labour and supplies, and successive or prior chemotherapy.

Results. Forty-one patients in the temozolomide group and 25 patients in the lomustine group were analysed. The median OS was 33.3 weeks (95% CI 28.4, 42.1 weeks) and 37.7 weeks (95% CI 25.0, 88.4 weeks) respectively (P=0.783). Temozolomide patients received a mean of 5.1 cycles of drug treatment, with a mean cost per patient of $10 746 (CAD). In contrast, lomustine patients received a mean of 3.3 cycles of therapy, with a mean cost per patient of $129 (CAD). The cost-effectiveness analysis showed that temozolomide was generally not a cost-effective strategy and that lomustine was the dominant strategy. In the sensitivity analysis, in scenarios where median OS was prolonged with temozolomide as compared to lomustine, the incremental cost-effectiveness ratio for each life year gained ranged from $32,247 to $162,186.

Conclusion. No difference in survival was observed between patients treated with single agent lomustine and temozolomide. Based on the higher cost and lack of additional clinical benefit of temozolomide, lomustine is a more cost-effective treatment strategy.

Key Words: cost-effectiveness • malignant gliomas • temozolomide

Journal of Oncology Pharmacy Practice, Vol. 12, No. 2, 105-111 (2006)
DOI: 10.1177/1078155206069161


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