Authors' objectives: To assess the efficacy/ effectiveness, safety and cost-effectiveness of 5-ALA in brain tumour surgery.

Authors' results and conclusions: Based on the review, 5-ALA improved progression free survival (PFS), gross total resection (GTR) and overall survival (OS) as compared to conventional treatment or white light surgery in high grade glioma (HGG). However, when compared with iMRI and fluorescein sodium, the difference was not significant. There was no difference in the outcome measure with low- or high-dose of 5-ALA. Overall, the used of 5-ALA was safe although there were a few incidence of transient elevation of liver enzymes and skin sensitivity which later on resolved without further treatment. On the economic side, 5-ALA have a potential of cost-effective as compared to white-light microscopy for HGGs. As for financial implication, the neurosurgical centre with the existing microscope system for 5-ALA will incur additional cost of RM6,800 per patient per year. Meanwhile, the neurosurgical centre with newly set-up microscope system for 5-ALA will require the treatment cost per patient per year range from RM13,000 to RM72,000.

Authors' recommendations: 5-ALA may be used as an intraoperative optical adjunct for HGG surgery.

Authors' methods: A systematic review was conducted. Review protocol and search strategy was developed by the main author and Information Specialist. The following electronic databases were searched through the Ovid interface: Ovid interface: Ovid MEDLINE® In-Process & Other Non-Indexed Citations and Ovid MEDLINE® 1946 to March 2022. Parallel searches were run in PubMed, US FDA, CADTH, and INAHTA database. No limits were applied to the search. Any additional articles were identified from reviewing the references of retrieved articles. The last search was performed on April 2022.

Authors' identified further research: The selection of the studies and appraisal was done by one reviewer. Besides, only English full text articles were included. There is also related full text articles could not retrieve because of database limitation.

Project Status: Completed

Year Published: 2021

URL for published report: https://www.moh.gov.my/index.php/database_stores/store_view_page/30/396

Requestor: Ministry of Health, decision-making committee

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Malaysia

Organisation Name: Malaysian Health Technology Assessment

Contact Address: Malaysian Health Technology Assessment Section, Ministry of Health Malaysia, Federal Government Administrative Centre, Level 4, Block E1, Parcel E, 62590 Putrajaya Malaysia Tel: +603 8883 1229

Contact Name: htamalaysia@moh.gov.my

Contact Email: htamalaysia@moh.gov.my

Copyright: Malaysian Health Technology Assessment Section (MaHTAS)