Should we continue temozolomide beyond six cycles in the adjuvant treatment of glioblastoma without an evidence of clinical benefit? A cost analysis based on prescribing patterns in Spain
Clin. transl. oncol. (Print)
; 16(3): 273-279, mar. 2014.
Article
in English
| IBECS
| ID: ibc-127734
Responsible library:
ES1.1
Localization: BNCS
ABSTRACT
PURPOSE:
The standard adjuvant treatment for glioblastoma is temozolomide concomitant with radiotherapy, followed by a further six cycles of temozolomide. However, due to the lack of empirical evidence and international consensus regarding the optimal duration of temozolomide treatment, it is often extended to 12 or more cycles, even in the absence of residual disease. No clinical trial has shown clear evidence of clinical benefit of this extended treatment. We have explored the economic impact of this practice in Spain. MATERIALS ANDMETHODS:
Spanish neuro-oncologists completed a questionnaire on the clinical management of glioblastomas in their centers. Based on their responses and on available clinical and demographic data, we estimated the number of patients who receive more than six cycles of temozolomide and calculated the cost of this extended treatment.RESULTS:
Temozolomide treatment is continued for more than six cycles by 80.5 % of neuro-oncologists 44.4 % only if there is residual disease; 27.8 % for 12 cycles even in the absence of residual disease; and 8.3 % until progression. Thus, 292 patients annually will continue treatment beyond six cycles in spite of a lack of clear evidence of clinical benefit. Temozolomide is covered by the National Health Insurance System, and the additional economic burden to society of this extended treatment is nearly 1.5 million euros a year.CONCLUSIONS:
The optimal duration of adjuvant temozolomide treatment merits investigation in a clinical trial due to the economic consequences of prolonged treatment without evidence of greater patient benefit (AU)RESUMEN
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Collection:
National databases
/
Spain
Health context:
Sustainable Health Agenda for the Americas
Health problem:
Goal 4: Health financing
Database:
IBECS
Main subject:
Brain Neoplasms
/
Glioblastoma
/
Antineoplastic Agents, Alkylating
/
Dacarbazine
Type of study:
Controlled clinical trial
/
Health economic evaluation
Limits:
Humans
Country/Region as subject:
Europa
Language:
English
Journal:
Clin. transl. oncol. (Print)
Year:
2014
Document type:
Article
Institution/Affiliation country:
Fundación Jiménez Díaz/Spain
/
Hospital 12 de Octubre/Spain
/
Hospital Arnau de Vilanova/Spain
/
Hospital Clínico San Carlos/Spain
/
Hospital Duran Reynals/Spain
/
Hospital General Virgen de la Luz/Spain
/
Hospital General de Albacete/Spain
/
Hospital General de Ciudad Real/Spain
/
Hospital Germans Trias i Pujol/Spain
/
Hospital Provincial de Castellón/Spain