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Real-world cost- effectiveness analysis: Tumor Treating Fields for newly diagnosed glioblastoma in China

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Abstract  

Background

Glioblastoma (GBM) stands as the most aggressive and prevalent primary brain malignancy. Tumor Treating Fields (TTFields), an innovative therapy complementing chemotherapy for GBM treatment, which can significantly enhance overall survival, disease progression-free survival, and patient’s quality of life. However, there is a dearth of health economics evaluation on TTFields therapy both domestically and internationally.

Objective

The study aims to assess the cost-effectiveness of TTFields + temozolomide (TMZ) in comparison to TMZ alone for newly diagnosed GBM patients. The intent is to provide robust economic evidence to serve as a foundation for policymaking and decision-making processes in GBM treatment.

Methods

We estimated outcomes for newly diagnosed GBM patients over a lifetime horizon using a partitioned survival model with three states: Progression-Free Survival, Progression Disease, and Death. The survival model was derived from a real-world study in China, with long-term survival data drawn from GBM epidemiology literature. Adverse event rates were sourced from the EF-14 trial data. Cost data, validated by expert consultation, was obtained from public literature and databases. Utility values were extracted from published literature. Using Microsoft Excel, we calculated expected costs and quality-adjusted life years (QALYs) over 15 years from a health system perspective. The willingness-to-pay threshold was set at three times the Chinese per capita Gross Domestic Product (GDP) in 2022, amounting to CN¥242,928 (US$37,655) /QALY. A 5% discount rate was applied to costs and utilities. Results underwent analysis through single factor and probability sensitivity analyses.

Results

TTFields + TMZ demonstrated a mean increase in cost by CN¥389,326 (US$57,859) and an increase of 2.46 QALYs compared to TMZ alone. The incremental cost-effectiveness ratio (ICER) was CN¥157,979 (US$23,474) per QALY gained. The model exhibited heightened sensitivity to changes in the discount rate. Probability sensitivity analysis indicates that, under the existing threshold, the probability of TTFields + TMZ being economical is 95.60%.

Conclusions

This cost-effectiveness analysis affirms that incorporating TTFields into TMZ treatment proves to be cost-effective, given a threshold three times the Chinese per capita GDP.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Tan AC, Ashley DM, López GY, Malinzak M, Friedman HS, Khasraw M (2020) Management of glioblastoma: State of the art and future directions. CA Cancer J Clin 70:299–312. https://doi.org/10.3322/caac.21613

    Article  PubMed  Google Scholar 

  2. Shan X, Fan X, Liu X, Zhao Z, Wang Y, Jiang T (2018) Clinical characteristics associated with postoperative seizure control in adult low-grade gliomas: a systematic review and meta-analysis. Neuro Oncol 20:324–331. https://doi.org/10.1093/neuonc/nox130

    Article  PubMed  Google Scholar 

  3. Ostrom QT, Gittleman H, Fulop J, Liu M, Blanda R, Kromer C, Wolinsky Y, Kruchko C, Barnholtz-Sloan JS (2015) CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2008–2012. Neuro Oncol 4:iv1–iv62. https://doi.org/10.1093/neuonc/nov189

    Article  Google Scholar 

  4. Stupp R, Mason WP, Van D, Weller M, Fisher B, Taphoorn M, Belanger K, Brandes AA, Marosi C, Bogdahn U (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996. https://doi.org/10.1056/NEJMoa043330

    Article  CAS  PubMed  Google Scholar 

  5. Zhu P, Du XL, Lu G, Zhu J-J (2017) Survival benefit of glioblastoma patients after FDA approval of temozolomide concomitant with radiation and bevacizumab: A population-based study. Oncotarget 8:44015–44031. https://doi.org/10.18632/oncotarget.17054

    Article  PubMed  PubMed Central  Google Scholar 

  6. Liu Y (2019) Diagnostic and Treatment Guidelines for Gliomas (2018 edition). Chin J Neurosurg 35:217–239. https://doi.org/10.3760/cma.j.issn.1001-2346.2019.03.001

    Article  Google Scholar 

  7. Yang P, Wang Y, Peng X, You G, Zhang W, Yan W, Bao Z, Wang Y, Qiu X, Jiang T (2013) Management and survival rates in patients with glioma in China (2004–2010): a retrospective study from a single-institution. J Neurooncol 113:259–266. https://doi.org/10.1007/s11060-013-1103-9

    Article  CAS  PubMed  Google Scholar 

  8. Jiang T, Jin Q, Zhang Z, Zhang D, Li S, Qiao H, Zhang W, Wang Y, Li G, Fang S (2020) Analysis of prognostic factors and long-term postoperative follow-up in 1828 adult patients with newly diagnosed gliomas in the cerebral hemisphere. Chin J Neurosurg 36:706–711. https://doi.org/10.3760/cma.j.cn112050-20200409-00225

    Article  Google Scholar 

  9. Nabors LB, Portnow J, Ahluwalia M, Baehring J, Brem H, Brem S, Butowski N, Campian JL, Clark SW, Fabiano AJ (2020) Central nervous system cancers, version 3.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 18:1537–1570. https://doi.org/10.6004/jnccn.2020.0052

    Article  PubMed  Google Scholar 

  10. CtotCGfDaToCNS G (2016) Chinese Guidelines for Diagnosis and Treatment of Central Nervous System Glioma (2015). Chin Med J 96:25. https://doi.org/10.3760/cma.j.issn.0376-2491.2016.07.003

    Article  Google Scholar 

  11. Jiang T, Nam D, Ram Z, Poon W, Wang J, Boldbaatar D, Mao Y, Ma W, Mao Q, You Y (2021) Clinical practice guidelines for the management of adult diffuse gliomas. Cancer Lett 499:60–72. https://doi.org/10.1016/j.canlet.2020.10.050

    Article  CAS  PubMed  Google Scholar 

  12. Burri SH, Gondi V, Brown PD, Mehta MP (2018) The evolving role of tumor treating fields in managing glioblastoma: guide for oncologists. Am J Clin Oncol 41:191–196. https://doi.org/10.1097/COC.0000000000000395

    Article  PubMed  Google Scholar 

  13. Riley MM, San P, Lok E, Swanson KD, Wong ET (2019) The clinical application of tumor treating fields therapy in glioblastoma. J Vis Exp 146:e58937. https://doi.org/10.3791/58937

    Article  CAS  Google Scholar 

  14. Rick J, Chandra A, Aghi MK (2018) Tumor treating fields: a new approach to glioblastoma therapy. J Neurooncol 137:447–453. https://doi.org/10.1007/s11060-018-2768-x

    Article  PubMed  Google Scholar 

  15. Guzauskas GF, Pollom EL, Stieber VW, Wang BC, Garrison LP Jr (2019) Tumor treating fields and maintenance temozolomide for newly-diagnosed glioblastoma: a cost-effectiveness study. J Med Econ 22:1006–1013. https://doi.org/10.1080/13696998.2019.1614933

    Article  PubMed  Google Scholar 

  16. Chen C, Xu H, Song K, Zhang Y, Zhang J, Wang Y, Sheng X, Chen L, Qin Z (2022) Tumor Treating Fields Combine with Temozolomide for Newly Diagnosed Glioblastoma: A Retrospective Analysis of Chinese Patients in a Single Center. J Clin Med 11:5855. https://doi.org/10.3390/jcm11195855

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Porter KR, McCarthy BJ, Berbaum ML, Davis FG (2011) Conditional survival of all primary brain tumor patients by age, behavior, and histology. Neuroepidemiology 36:230–239. https://doi.org/10.1159/000327752

    Article  PubMed  PubMed Central  Google Scholar 

  18. Shi F, Shang Y, Rui M, Ma A (2020) Application of SurvHE Package of R for Health Economic Evaluation. Chinese Health Economics 39:9–14. https://doi.org/10.7664/CHE20200902

    Article  Google Scholar 

  19. He X, Aixia M (2020) Discussion on simulation method of survival curve of tumor immunotherapy in pharmacoeconomics. Chinese Health Economics 39:58–61. https://doi.org/10.7664/CHE20201014

    Article  Google Scholar 

  20. Yaozh.com (2023) Drug bidding information database. Yaozh.com. https://db.yaozh.com/. Accessed 11 March 2023

  21. Stupp R, Taillibert S, Kanner A, Read W, Steinberg DM, Lhermitte B, Toms S, Idbaih A, Ahluwalia MS, Fink K (2017) Effect of tumor-treating fields plus maintenance temozolomide vs maintenance temozolomide alone on survival in patients with glioblastoma: a randomized clinical trial. JAMA 318:2306–2316. https://doi.org/10.1001/jama.2017.18718

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Hu H, Mu Q, Bao Z, Chen Y, Liu Y, Chen J, Wang K, Wang Z, Nam Y, Jiang B (2018) Mutational landscape of secondary glioblastoma guides MET-targeted trial in brain tumor. Cell 175:1665–1678. https://doi.org/10.1016/j.cell.2018.09.038

    Article  CAS  PubMed  Google Scholar 

  23. Liu G (2020) China Guidelines for Pharmacoeconomic Evaluations 2020 Edition. China Market Press, Peking

    Google Scholar 

  24. Jiang Y, Wang X (2022) Cost-effectiveness analysis of pembrolizumab plus standard chemotherapy versus chemotherapy alone for first-line treatment of metastatic non-squamous non–small-cell lung cancer in China. Eur J Hosp Pharm 29:139–144. https://doi.org/10.1136/ejhpharm-2020-002208

    Article  PubMed  Google Scholar 

  25. Liu G, Kang S, Wang X (2021) Pharmacoeconomic Evaluation of Pembrolizumab in First-line Treatment of Advanced Non-small Cell Lung Cancer with High PD-L1 Expression. Chin Pharm 32:1351–1356. https://doi.org/10.6039/j.issn.1001-0408.2021.11.12

    Article  Google Scholar 

  26. Wumaier K, Li W, Chen N, Cui J (2021) Direct oral anticoagulants versus low molecular weight heparins for the treatment of cancer-associated thrombosis: a cost-effectiveness analysis. Thromb J 19:68. https://doi.org/10.1186/s12959-021-00319-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Liu X (2019) Health economics analysis of phenobarbital in treating epilepsy in primary health institutions. Diet and Health Care 6(44):270–271

    Google Scholar 

  28. Wu B, Zhang Q, Sun J (2018) Cost-effectiveness of nivolumab plus ipilimumab as first-line therapy in advanced renal-cell carcinoma. J Immunother Cancer 6:124. https://doi.org/10.1186/s40425-018-0440-9

    Article  PubMed  PubMed Central  Google Scholar 

  29. Zhang D, Li X, Ding J, Ke X, Ding W, Ren Y, Xu H, Li H, Ma A, Tang W (2021) Value of Perampanel as Adjunctive Treatment for Partial-Onset Seizures in Epilepsy: Cost-Effectiveness and Budget Impact Analysis. Front Public Health 9:670108. https://doi.org/10.3389/fpubh.2021.670108

    Article  PubMed  PubMed Central  Google Scholar 

  30. Garside R, Pitt M, Anderson R, Rogers G, Dyer M, Mealing S, Somerville M, Price A, Stein K (2007) The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma: a systematic review and economic evaluation. Health Technol Assess 11:iii–iv. https://doi.org/10.3310/hta11450

    Article  PubMed  Google Scholar 

  31. Dryhurst S, Schneider CR, Kerr J, Freeman ALJ, Recchia G, van der Bles AM, Spiegelhalter D, van der Linden S (2020) Risk perceptions of COVID-19 around the world. J Risk Res 23:994–1006. https://doi.org/10.1080/13669877.2020.1758193

    Article  Google Scholar 

  32. Hatswell AJ, Bullement A, Briggs A, Paulden M, Stevenson MD (2018) Probabilistic Sensitivity Analysis in Cost-Effectiveness Models: Determining Model Convergence in Cohort Models. Pharmacoeconomics 36:1421–1426. https://doi.org/10.1007/s40273-018-0697-3

    Article  PubMed  Google Scholar 

  33. Bernard-Arnoux F, Lamure M, Ducray F, Aulagner G, Honnorat J, Armoiry X (2016) The cost-effectiveness of tumor-treating fields therapy in patients with newly diagnosed glioblastoma. Neuro Oncol 18:1129–1136. https://doi.org/10.1093/neuonc/now102

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

The authors declare that no funds.

Author information

Authors and Affiliations

  1. School of Public Health, Fudan University, Shanghai, China

    Yuliang Xiang, Yingyao Chen, Zian Xu, Shanyan Zhou, Dunming Xiao & Shimeng Liu

  2. National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, 130 Dongan Rd, Xuhui, Shanghai, 200032, China

    Yuliang Xiang, Yingyao Chen, Zian Xu, Shanyan Zhou, Dunming Xiao & Shimeng Liu

  3. Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Zhiyong Qin & Lingchao Chen

  4. National Center for Neurological Disorders, Shanghai, 200040, China

    Zhiyong Qin & Lingchao Chen

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  1. Yuliang Xiang
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Contributions

Shimeng Liu and Yingyao Chen contributed to the study conception and design. Material preparation, data collection were performed by Zian Xu, Shanyan Zhou, Zhiyong Qin,and Lingchao Chen. Data analysis was performed by Yuliang Xiang, Shimeng Liu,and Dunming Xiao. The first draft of the manuscript was written by Yuliang Xiang and Shimeng Liu. Zhiyong Qin and Lingchao Chen provided research clinical data.

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Correspondence to Shimeng Liu.

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Xiang, Y., Chen, Y., Xu, Z. et al. Real-world cost- effectiveness analysis: Tumor Treating Fields for newly diagnosed glioblastoma in China. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04662-x

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