Cost-effectiveness of radiation and chemotherapy for high-risk low-grade glioma

Background. The addition of procarbazine, lomustine, vincristine (PCV) chemotherapy to radiotherapy (RT) for patients with high-risk (=40 y old or subtotally resected) low-grade glioma (LGG) results in an absolute median survival benefit of over 5 years. We evaluated the cost-effectiveness of this treatment strategy. Methods. A decision tree with an integrated 3-state Markov model was created to follow patients with high-risk LGG after surgery treated with RT versus RT + PCV. Patients existed in one of 3 health states: stable, progressive, or dead. Survival and freedom from progression were modeled to reflect the results of RTOG 9802 using timedependent transition probabilities. Health utility values and costs of care were derived from the literature and national registry databases. Analysis was conducted from the health care perspective. Deterministic and probabilistic sensitivity analysis explored uncertainty in model parameters. Results. Modeled outcomes demonstrated agreement with clinical data in expected benefit of addition of PCV to RT. The addition of PCV to RT yielded an incremental benefit of 4.77 quality-adjusted life-years (QALYs) (9.94 for RT + PCV vs 5.17 for RT alone) at an incremental cost of $48 635 ($188 234 for RT + PCV vs $139 598 for RT alone), resulting in an incremental cost-effectiveness ratio of $10 186 per QALY gained. Probabilistic sensitivity analysis demonstrates that within modeled distributions of parameters, RT + PCV has 99.96% probability of being costeffectiveness at a willingness-to-pay threshold of $100 000 per QALY. Conclusion. The addition of PCV to RT is a cost-effective treatment strategy for patients with high-risk LGG.