SURG-22. QUALITY BASED ASSESSMENT OF THE COST-EFFECTIVENESS OF 5-ALA IN HIGH GRADE GLIOMA SURGERY: A SYSTEMATIC REVIEW

Abstract

BACKGROUND: High grade gliomas (HGG) are the most common primary malignant brain tumors in adults. While the infiltrative nature of HGG makes safe maximal resections challenging, studies on the use of adjuncts such as 5-ALA have shown much promise. The accumulating clinical evidence has led to approval of 5-ALA for clinical practice in Europe but not in North America. Prior to integration into routine practice, data on the health economic impact of novel agents are considered by regulatory health agencies. With respect to 5-ALA, this evidence is limited and requires further investigation. OBJECTIVE: A systematic review and synthesis of the state of evidence on health economic assessment of 5-ALA in HGG surgery was conducted. METHODS: Medline, EMBASE, CRD, EconPapers and Cochrane databases were searched for keywords related to glioma, cost-effectiveness and 5-ALA. RESULTS: Three primary studies were identified (1 Portuguese, 1 Spanish and 1 French). One measured incremental cost-effectiveness ratio (ICER) of 5-ALA per gained Quality Adjusted Life Year (QALY) compared to white light surgery. Another assessed cost-effectiveness based on incremental cost per QALY and per complete resection. The first study reported ICER of €9100/ QALY while the second reported €9021/QALY. Both studies reported that 5-ALA was well below their respective national cost-effectiveness thresholds. The third study compared glioblastoma (GBM) surgical costs during a period before 5-ALA's introduction and after it started being widely used. The difference in average costs of GBM surgery during these periods, €9353 compared to €10,118, was not significant. None of these studies considered patient's perspective and indirect costs in their analysis. CONCLUSIONS: While clinical evidence in favor of 5-ALA as intraoperative adjunct is accumulating, health economic data is limited and of low quality. Prospective high quality evaluations on cost-effectiveness of 5-ALA are necessary prior to its regulatory approval and routine clinical use in North America.