Cost Minimization Analysis of Conventional vs. Short-Course Radiotherapy with Temozolomide for Non-Elderly Patients with Newly Diagnosed Glioblastoma

Abstract

<h3>Purpose/Objective(s)</h3> Standard of care for adults aged 70 years or younger with an ECOG performance status of 0-2 and newly diagnosed glioblastoma is maximal safe resection followed by radiotherapy/RT (60 Gy in 30 fractions) with concurrent temozolomide/TMZ (75mg/m2) followed by 6-12 months of adjuvant TMZ (150-200 mg/m2). Recently a phase III non-inferiority trial compared conventional (60 Gy in 30 fractions) RT with TMZ versus short-course (60 Gy in 20 fractions) RT with TMZ and found that short-course RT with TMZ was non-inferior on two separate interim analyses conducted to date. <h3>Materials/Methods</h3> We performed a cost minimization analysis to determine the cost savings of short-course RT with TMZ versus conventional RT with TMZ for patients with newly diagnosed glioblastoma. All the resources necessary to deliver the two treatment regimens including the time and expertise of various health care professionals, supplies, infrastructure, and other means were identified by experienced clinicians at our institution. Shared costs between the two different treatment regimens were identified, as they cancel each other out, and were not included in our analysis. Costs were obtained from several sources including institutional databases, collective bargaining agreements, Minister of Health cost documents, and expert elicitation. All costs were analyzed in 2022 Canadian dollars (CAD). Any cost parameters used within the model that are older than the year 2021 were inflation adjusted using the Bank of Canada inflation adjustment calculator. <h3>Results</h3> The non-shared treatment costs of one patient treated using conventional RT with TMZ versus short-course RT with TMZ was $22 532.97 and $15 021.98 respectively. Short-course RT with TMZ therefore saves $7510.89 dollars per patient treated relative to conventional RT with TMZ. For every 60 patients treated with short-course RT with TMZ, the salary of one full time radiation oncology staff position equivalent in Alberta and 600 treatment slots are recovered <h3>Conclusion</h3> For patients with newly diagnosed glioblastoma, short-course RT with TMZ leads to cost savings compared to conventional RT with TMZ. Short-course RT with TMZ also reduces the number of treatment slots needed for these patients, which has potential for improved wait times and access to RT for other cancer patients.