Abstract

The EF-14 trial demonstrated that adding tumor treating fields (TTFields) to maintenance temozolomide (TMZ) significantly extends progression-free survival (PFS) and overall survival (OS) for newly diagnosed glioblastoma (GBM) patients. We assessed the cost-effectiveness of TTFields and TMZ for newly diagnosed GBM from the U.S. healthcare system perspective.Outcomes for newly diagnosed GBM patients were estimated over a lifetime horizon using an area under the curve model with three states: stable disease, progressive disease, or death. The survival model integrated the 5-year EF-14 trial results with long-term GBM epidemiology data and U.S. background mortality rates. Adverse event rates were derived from the EF-14 trial data. Utility values to determine quality-adjusted life-years, adverse event costs and supportive care costs were obtained from published literature. We applied a 3% discount rate to future costs and outcomes. One-way and probabilistic sensitivity analyses were performed to assess result uncertainty due to parameter variability.Treatment with TTFields and TMZ was estimated to result in a mean increase in survival of 1.25 life years (95% credible range [CR]: 0.89 to 1.67) and 0.96 quality-adjusted life years (QALYs) (95% CR: 0.67 to 1.30) compared to treatment with TMZ alone. The incremental total cost was $188,637 (95% CR: $145,324 to $225,330). The incremental cost-effectiveness ratio (ICER) was $150,452 per life year gained and $197,336 per QALY gained. The model was most sensitive to changes in the cost of TTFields treatment.Adding TTFields to maintenance TMZ resulted in a substantial increase in the estimated mean lifetime survival and quality-adjusted survival for newly diagnosed GBM patients. Treatment with TTFields can be considered cost-effective within the reported range of willingness-to-pay thresholds in the United States.

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