Cost-Effectiveness Analysis of Bevacizumab, Fotemustine and Extended-Dose Temozolomide in Patients with Recurrent Glioblastoma in Spain

Abstract

The treatment of glioblastoma after first-line treatment progression is not clearly established in Spain. Most accepted alternatives are nitrosoureas (fotemustine, F) extended-dose temozolomide (eT) or bevacizumab (B). Without clear standards of care, increased clinical and health policy uncertainty among decision makers should be clarified. So, economic evaluation might reduce those uncertainties. Objectives: To analyze the cost-effectiveness of bevacizumab, extended-dose temozolomide and fotemustine in patients with either recurrent or progressive glioblastoma after standard therapy, compared to standard clinical practice (SCP). Methods: A costeffectiveness markov model was conducted from a payer perspective (time horizon 1 year, 3%, discount rate, 2012, € ). Our model got three health states: alive without progression, alive with toxicity and progression as absorbing state. We subsequently performed a deterministic and probabilistic analysis of sensitivity. Main efficacy outcome was progression-free survival at six months (6m PFS). Toxicity data was based on relevant phase II studies. Health state utility values were estimated based on published values from an HTA report by Garside et al, 2007. Costs were obtained from a Spanish University Hospital. Results: Cost/effectiveness ratios were: SCP (based on carmustine) 2,368.45 € /year to obtain 6m PFS with stable health state utility value, F 4,112.97 € /year, B 15,122.49 € /year and eT 5,470.05 € /year. Incremental cost-effectiveness ratios were: F 7,404.12 € /year € /year to obtain 6m PFS with stable health state utility value, B 40,371.8 € /year and eT 45,853.51 € /year. Tornado diagram and CEAC showed our results robustness. Conclusions: ICER analysis shows fotemustine to be the dominant option in the treatment of patients with recurrent or progressive glioblastoma.