Temozolomide for malignant gliomas in British Columbia: A population-based cost-effectiveness analysis
Bibliographic record
Abstract
Study objectives. To evaluate the cost-effectiveness and outcomes achieved in patients with recurrent malignant glioma treated with temozolomide in British Columbia, as compared to previous lomustine use in the same patient population, and to temozolomide literature reports. Outcomes assessed included median overall survival, 6-month overall survival and 6-month progression free survival. Methods. A retrospective analysis was conducted to identify patients who received single-agent temozolomide or lomustine during successive, prespecified time periods. Data was collected on survival, disease progression, duration of therapy, cost of drug, labour and supplies, and successive or prior chemotherapy. Results. Six-month progression free survival (PFS) occurred in 52% and 42.9% of patients in the temozolomide and lomustine cohorts, respectively (P=0.44). Six-month overall survival and median overall survival (OS) were 72% and 40.86 weeks for temozolomide patients and 64.3% and 46.7 weeks for lomustine patients. These outcomes were not statistically different between the two treatment groups. Associated with these outcomes, temozolomide patients received a median of six cycles of drug treatment, with a median cost per patient of $11 660 (CAN). Alternatively, lomustine patients received a median of four cycles with a median cost per patient of $189 (CAN). In the cost-effectiveness analysis for median OS, temozolomide was not a cost-effective alternative, and for 6-month PFS, the incremental cost effectiveness ratio (ICER) of temozolomide was $1261 (CAN) for each additional percent of patients progression free at 6-months. Sensitivity analysis varying both median OS and 6-month PFS resulted in ICER’s of temozolomide ranging from $332 to $3277. Conclusions. No significant differences in outcomes were observed between patients treated with single-agent lomustine or temozolomide. Temozolomide therapy has an incremental cost increase over lomustine of $11 471 per patient. It appears when only survival outcomes and direct treatment costs are considered, lomustine is a more cost-effective treatment strategy in the specific setting of recurrent malignant glioma.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".