The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high grade glioma: a systematic review and economic evaluation

Garside R, Pitt M, Anderson R, Rogers G, Dyer M, Mealing S, et al
Record ID 32007000632
Authors' objectives:

"This report assesses the clinical and cost-effectiveness of: adjuvant BCNU-W with surgery and radiotherapy, compared with surgery and radiotherapy alone adjuvant and concomitant TMZ with surgery and radiotherapy, compared with surgery and radiotherapy alone." (from executive summary)

Authors' recommendations: BCNU-W has not been proven to confer a significant advantage in survival for patients with grade III tumours when treated with the drug, compared with placebo. There does not appear to be a survival advantage for patients with grade IV tumours. No increase in PFS has been shown. Limited evidence suggests a small but significant advantage in both overall survival and PFS with TMZ among a mixed population with grade IV and grade III (7;8%) tumours. However, it remains unclear whether this is true in grade IV tumours alone. On the basis of best available evidence, we consider that neither BCNU-W nor TMZ is likely to be considered cost-effective by NHS decision-makers. However, data for the model were drawn from limited evidence of variable quality. Tumour type is clearly important in assessing patient prognosis with different treatments. Grade IV tumours are commonest and appear to have least chance of response. There were too few grade III tumours included to carry out a formal assessment, but they appear to respond better and drive results for both drugs. Future use of genetic and biomarkers may help identify subtypes which will respond, but current licensing indications do not specify these.
Authors' methods: Review
Project Status: Completed
URL for project:
Year Published: 2007
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Cost-Benefit Analysis
  • Drug Costs
  • Drug Implants
  • Antineoplastic Combined Chemotherapy Protocols
  • Astrocytoma
  • Carmustine
  • Dacarbazine
  • Glioblastoma
  • Glioma
  • Supratentorial Neoplasms
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name:
Contact Email:
Copyright: 2009 Queen's Printer and Controller of HMSO
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.