Current trends in the management of glioblastoma in a French University Hospital and associated direct costs
Résumé
What is new and objectives Trends in the care of glioblastoma in actual practice settings are poorly described. In a previous pharmacoepidemiologic study, we highlighted changes in the management of patients with glioblastoma (GBM) newly diagnosed between 2004 and 2008. Our aim was to complete and to extend the previous report with a study of a cohort of patients diagnosed in 2011 to emphasize the trends in the pharmacotherapy of GBM over the last decade. Methods A single-centre study was undertaken of three historic cohorts of GBM patients newly diagnosed during years 2004, 2008 and 2011 (corresponding to groups 1, 2 and 3, respectively) but limited to patients eligible for radiotherapy after initial diagnosis. The type of medical management was described and compared, as well as overall survival and total cost from diagnosis to death or the last follow-up date. Cost analysis was performed from the French sickness fund perspective using tariffs from 2014. Results Two hundred and seventeen patients (49 in Group 1, 73 in Group 2, 95 in Group 3) were selected with similar baseline characteristics. Fluorescence-guided surgery using 5-ALA was increasingly used over the three periods. There was a strong trend towards broader use of temozolomide radiochemotherapy (39%, 73% and 83% of patients, respectively) as first-line treatment as well as bevacizumab regimen at recurrence (6%, 48% and 58% of patients, respectively). The increase in overall survival between Group 2 and Group 1 was confirmed for patients in Group 3 (17·5 months vs. 10 months in Group 1). The mean total cost per patient was 53368 € in Group 1, 70 201 € in Group 2 and 78355 € in Group 3. Hospital care represented the largest expenditure (75%, 59% and 60% in groups 1, 2 and 3, respectively) followed by chemotherapy drug costs (11%, 30% and 29%, respectively). What is new and conclusion This is the first study to report on changes in the management of GBM in real-life practice. The ten-year study indicates an improvement in overall survival but also an increase in total cost of care. The data should be useful for informing the care of GBM patients in settings similar to ours. Figure 1 shows Kaplan Meier curves of overall survival for the three cohorts of patients and emphasizes the improvement of care over the last decade. © 2016 John Wiley & Sons Ltd.
Mots clés
bevacizumab
temozolomide
antineoplastic agent
adult
Article
cancer chemotherapy
cancer diagnosis
cancer radiotherapy
cancer recurrence
cancer surgery
cancer survival
cancer therapy
clinical article
clinical practice
controlled study
cost benefit analysis
drug cost
fluorescence guided surgery
follow up
France
health care cost
hospital care
human
long term care
overall survival
palliative therapy
trend study
university hospital
analogs and derivatives
Brain Neoplasms
economics
procedures
tumor recurrence
Aged
Antineoplastic Agents
Bevacizumab
Chemoradiotherapy
Dacarbazine
Drug Costs
Female
Follow-Up Studies
Glioblastoma
Health Care Costs
Hospitalization
Hospitals
University
Humans
Male
Middle Aged
Neoplasm Recurrence
Local
Survival Rate