The value of using a brain laser interstitial thermal therapy (LITT) system in patients presenting with high grade gliomas where maximal safe resection may not be feasible.

Jeffrey D Voigt,Gene Barnett

doi:10.1186/s12962-016-0055-2

Abstract

BackgroundThe objective of this analysis was to determine the value (incremental cost/increment benefit) of a brain LITT system versus employing current surgical options recommended by NCCN guidelines, specifically open resection (i.e. craniotomy) methods or biopsy (collectively termed CURRENT TREATMENTS) in patients where maximal safe resection may not be feasible. As has been demonstrated in the literature, extent of resection/ablation with minimal complications are independently related to overall survival.MethodsA cost effectiveness analysis from a societal perspective was employed using TreeAge Pro 2014 software. Direct costs (using national average Medicare reimbursement amounts), outcomes (overall survival), and value [defined as increment cost/incremental survival—evaluated as cost/life year gained (LYG)] were evaluated. Sensitivity analysis was also performed to determine which variables had the largest effect on incremental costs and outcomes.ResultsIn the base case, the overall survival was improved with brain LITT versus CURRENT TREATMENTS by 3.07 months at an additional cost of $7508 (or $29,340/LYG). This amount was significantly less than the current international threshold value for $32,575/LYG and considerably less than the US threshold value of $50,000/LYG. This incremental cost may also qualify under NICE criteria for end of life therapies. In sensitivity analysis: As percent local recurrence GBM increased; cost of DRG25/26 increased; percent GTR increased; and gliadel use increased—the value of brain LITT improved. Additionally, in those patients where a biopsy is the only option, brain LITT extended life by 7 months.ConclusionsBrain LITT should be considered a viable option for treatment of high grade gliomas as it improves survival at a cost which appears to be of good value to society. This incremental cost is less than the international and US thresholds for good value.

Highlights

The objective of this analysis was to determine the value of a brain laser interstitial thermal therapy (LITT) system versus employing current surgical options recommended by national comprehensive cancer network (NCCN) guidelines, open resection methods or biopsy in patients where maximal safe resection may not be feasible
One of the main issues with tumors that are in or near areas of eloquence or, that are deep seated in nature, is an inability for neurosurgeons to adequately resect the tumor without causing longer term neurological complications from surgery
As can be seen in the base case, the additional costs with LITT vs. CURRENT TREATMENTS is $7508 and the overall improved survival with brain LITT vs. CURRENT TREATMENTS is 3.07 months. As it relates to cost effectiveness, for every month in survival gained, it would cost an additional $2445 in using brain LITT versus CURRENT TREATMENTS

Summary

Introduction

The objective of this analysis was to determine the value (incremental cost/increment benefit) of a brain LITT system versus employing current surgical options recommended by NCCN guidelines, open resection (i.e. craniotomy) methods or biopsy (collectively termed CURRENT TREATMENTS) in patients where maximal safe resection may not be feasible. Craniotomy procedures that have been performed on high-grade gliomas in or near areas of eloquence have historically resulted in neurological complications (i.e. functional and/or cognitive deficits on a neurological basis) that are permanent in nature and result in suboptimal resection These major complication rates range from 4.5 to 13 % in large cohorts of patients [8,9,10,11,12,13,14,15,16,17] and result in suboptimal EOR of 78–

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Conclusion