High-grade astrocytomas: resource use, clinical outcomes, and cost of care.

Abstract

To describe the clinical course, survival, resource use, and direct medical costs of care for patients with high-grade astrocytomas. All patients with grade 3 or 4 astrocytoma who resided in Olmsted County, Minnesota, or one of the six adjacent counties and had a tissue diagnosis first made between 1987 and 1992 were studied. Clinical characteristics, initial management, use of resources, clinical course, survival, and medical charges were analyzed. Sixty-four patients, with a mean age of 62 years, were identified; 81% had glioblastoma multiforme. Approximately 60% underwent surgical resection, 80% had radiotherapy, and 50% had chemotherapy for initial management. After initial treatment (median duration, 116 days), approximately 75% of patients had a course with stable disease (median duration, 198 days). The overall median duration of survival was 323 days; lower grade and younger age were significantly associated with longer median survival-for example, 1,493 days for patients younger than 65 years with grade 3 astrocytomas and 205 days for patients 65 years old or older with grade 4 astrocytomas. The mean total direct medical charges were $67,887. In most patients with high-grade astrocytomas, a substantial period elapsed before disease progressed. Although the overall median duration of survival was less than 1 year, younger patients, especially those with grade 3 astrocytomas, had a longer survival. The management of patients with high-grade astrocytomas uses substantial health-care resources.