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.
Fisher PG , Buffler PA.Malignant gliomas in 2005 where to GO from here?JAMA2005; 293: 615-617 .
2.
Greanya ED , Taylor SCM , Hu F , Barnett J , Thiessen B.Temozolomide for malignant gliomas in British Columbia: a population-based cost-effectiveness analysis . J Oncol Pharm Practice2004; 10: 201-209 .
3.
Chang SM , Theodosopoulos P , Lamborn K , Malec M , Rabbitt J , Page M , Prados MD.Temozolomide in the treatment of recurrent malignant glioma . Cancer2004; 100: 605-611 .
4.
Brandes AA , Ermani M , Basso U , Paris MK , Lumachi F , Berti F , Amista` P , Gardiman M , Iuzzolino P , Turazzi S , Monfardinia S.Temozolomide in patients with glioblastoma at second relapse after first line nitrosoureaprocarbazine failure: a phase II study . Oncology2002; 63: 38-41 .
5.
Yung WKA , Prados MD , Yaya-Tur R , Rosenfeld SS , Brada M , Friedman HS , Albright R , Olson J , Chang SM , O’Neill AM , Friedman AH , Bruner J , Yue N , Dugan M , Zaknoen S , Levin VA.Multicenter phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse . J Clin Oncol1999; 17: 2762-2771 .
6.
Bower M , Newlands ES , Bleehan NM , Brada M , Begent RJ , Calvert H , Colquhoun I , Lewis P , Brampton MH.Multi-centre CRC phase II trial of temozolomide in recurrent or progressive high grade glioma . Cancer Chemother Pharmacol1997; 40: 484-488 .
7.
Brada M , Hoang-Xuan K , Rampling R , Dietrich PY , Dirix LY , Macdonald D , Heimans JJ , Zonnenberg BA , Bravo-Marques JM , Henriksson R , Stupp R , Yue N , Bruner J , Dugan M , Rao S , Zaknoen S.Multicenter phase II trial of temozolomide in patients with glioblastoma multiforme at first relapse . Ann Oncol2001; 12: 259-266 .
8.
Brandes AA , Ermani M , Basso U , Amista P , Berti F , Scienza R , Rotilio A , Pinna G , Gardiman M , Monfardini S.Temozolomide as a second-line systemic regimen in recurrent high-grade glioma: a phase II study . Ann Oncol2001; 12: 255-257 .
9.
Yung WKA , Albright RE , Olson J , Fredericks R , Fink K , Prados MD , Brada M , Spence A , Hohl RJ , Shapiro W , Glantz M , Greenberg H , Selker RG , Vick NA , Rampling R , Friedman H , Phillips P , Bruner J , Yue N , Osoba D , Zaknoen S , Levin VA.A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse . Br J Cancer2000; 83: 588-593 .
10.
Chibbaro S , Benvenuti L , Caprio A , Carnesecchi S , Pulera F , Faggionato F , Serino D , Galli C , Andreuccetti M , Buxton N , Gagliardi R.Temozolomide as first line agent in treating high-grade gliomas: phase II study . J Neurooncol2004; 67: 77-81
11.
Taylor SCM , Uyeno KT , O’Reilly SE , Murphy KC , Kapty ADK.Development of a systemic therapy costing model in a provincial oncology centre (abstract) . Eur J Cancer2000; 36: S26-S26 .
12.
Taylor SCM , Chow L.Development of a pharmacoeconomics service in a provincial oncology program (abstract) . Eur J Cancer1997; 33: S31-S31 .
13.
Stupp R , Dietrich PY , Ostermann Kralijevic S , Pica A , Maillard I , Maeder P , Meuli R , Janzer R , Pizzolato G , Miralbell R , Porchet F , Regli L , de Tribolet N , Mirimanoff RO , Leyvraz S.Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide . J Clin Oncol2002; 20: 1375-1382 .
14.
Stupp R , Mason WP , Van Den Bent MJ , et al.Concomitant and adjuvant temozolomide and radiotherapy for newly diagnosed glioblastoma mutliforme. Conclusive results of a randomized phase III trial by the EORTC Brain & RT Groups and NCIC Clinical Trials Group (abstract 2) . Proc Am Soc Clin Oncol2004; 23: 1-1 .
