Tag: quality-adjusted life year

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Global economic differences in modern glioblastoma care – a systematic review

Acta Neurochirurgica (2026) 168:89

This systematic review quantifies global cost and cost-effectiveness differences in contemporary glioblastoma (GBM) care, analyzing 21 studies standardized to 2024 USD. It reports extreme heterogeneity in direct medical costs—from about $18,908 in India to $356,481 in the United States—and identifies inpatient care and adjuvant therapies as primary cost drivers in high-income settings.

Economic models reveal that the full Stupp protocol often exceeds willingness-to-pay thresholds in middle- and low-income countries, while surgical resection and 5‑ALA fluorescence-guided surgery show relatively favorable cost-effectiveness. The authors call for standardized cost reporting and inclusion of societal perspectives to improve cross-country comparisons and policy decisions.

Purpose Quantified global differences in costs and cost-effectiveness of modern Stupp-protocol–based glioblastoma care via a systematic review.

Methods Searched PubMed/MEDLINE/Cochrane to Dec 1, 2025 using (Glioblastoma OR GBM) AND (costs OR cost-effectiveness OR economic burden); included studies with quantifiable economic outcomes from 2005 onward, yielding 21 eligible studies.

Standardization Converted all reported costs to 2024 USD by inflating with country-specific CPI to 2024 and converting using 2024 PPP rates.

Direct costs range Direct medical costs were highly heterogeneous, from about $356,481 (United States) to about $18,908 (India), across 15,547 real-world patients.

Cost drivers (Western systems) Adjuvant treatment and inpatient care were major contributors to direct medical costs in western countries (with inpatient care and radiotherapy prominent in US analyses).

Stupp protocol affordability The Stupp protocol exceeded willingness-to-pay thresholds in middle-income/resource-limited settings, indicating substantial financial burden in those contexts.

TTF cost-effectiveness variability Tumor treating fields (TTF) showed very high ICERs in France (≈ $862k–$940k per LYG) and $252,590 per LYG in the US, but a more favorable estimate of $45,813.91 per QALY in China.

Key implication Uniform, standardized cost reporting is needed to better compare cost-effectiveness across countries; economic findings also underscore the role of surgery as a cost-effective component of modern GBM management.

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Surgical Management of Trigeminal Neuralgia: Use and Cost-Effectiveness From an Analysis of the Medicare Claims Database

SnapShotPNGOID_38_20121112T070408_110023

Neurosurgery 75:220–226, 2014

Trigeminal neuralgia is a relatively common neurosurgical pathology with multiple management options. Microvascular decompression (MVD) is nonablative and is considered the gold standard. However, stereotaxic radiosurgery (SRS) and percutaneous stereotaxic rhizotomy (PSR) are 2 noninvasive but ablative options that have rapidly gained support.

OBJECTIVE: To use Medicare claims data in conjunction with a literature review to assess the usage, effectiveness, and cost-effectiveness of the 3 different invasive treatments for trigeminal neuralgia.

METHODS: All of the claims of trigeminal neuralgia treatment were extracted from the 2011 5% Inpatient and Outpatient Limited Data Set. Current Procedural Terminology, 4th Edition/International Classification of Diseases, Ninth Revision codes for the 3 different surgical treatment modalities were used to further classify these claims. Kaplan-Meier survival curves in key articles were used to calculate quality-adjusted life years and costeffectiveness for each procedure.

RESULTS: A total of 1582 claims of trigeminal neuralgia were collected. Ninety-four (6%) patients underwent surgical intervention. Forty-eight (51.1%) surgical patients underwent MVD, 39 (41.5%) underwent SRS, and 7 (7.4%) underwent PSR. The average weighted costs for MVD, SRS, and PSR were $40 434.95, $38 062.27, and $3910.64, respectively. The qualityadjusted life yearswere 8.2 forMVD, 4.9 for SRS, and 6.5 for PSR. The cost per quality-adjusted life year was calculated as $4931.1, $7767.8, and $601.64 for MVD, SRS, and PSR, respectively.

CONCLUSION: This study shows that the most frequently used surgical management of trigeminal neuralgia is MVD, followed closely by SRS. PSR, despite being the most cost-effective, is by far the least utilized treatment modality.

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Cost-effectiveness analysis: comparing single-level cervical disc replacement and single-level anterior cervical discectomy and fusion

CDR

J Neurosurg Spine 19:546–554, 2013

In recent years, there has been increased interest in the use of cervical disc replacement (CDR) as an alternative to anterior cervical discectomy and fusion (ACDF). While ACDF is a proven intervention for patients with myelopathy or radiculopathy, it does have inherent limitations. Cervical disc replacement was designed to preserve motion, avoid the limitations of fusion, and theoretically allow for a quicker return to activity. A number of recently published systematic reviews and randomized controlled trials have demonstrated positive clinical results for CDR, but no studies have revealed which of the 2 treatment strategies is more cost-effective. The purpose of this study was to evaluate the cost-effectiveness of CDR and ACDF by using the power of decision analysis. Additionally, the authors aimed to identify the most critical factors affecting procedural cost and effectiveness and to define thresholds for durability and function to focus and guide future research.

Methods. The authors created a surgical decision model for the treatment of single-level cervical disc disease with associated radiculopathy. The literature was reviewed to identify possible outcomes and their likelihood following CDR and ACDF. Health state utility factors were determined from the literature and assigned to each possible outcome, and procedural effectiveness was expressed in units of quality-adjusted life years (QALYs). Using ICD-9 procedure codes and data from the Nationwide Inpatient Sample, the authors calculated the median cost of hospitalization by multiplying hospital charges by the hospital-specific cost-to-charge ratio. Gross physician costs were determined from the mean Medicare reimbursement for each current procedural terminology (CPT) code. Uncertainty as regards both cost and effectiveness numbers was assessed using sensitivity analysis.

Results. In the reference case, the model assumed a 20-year duration for the CDR prosthesis. Cervical disc replacement led to higher average QALYs gained at a lower cost to society if both strategies survived for 20 years ($3042/QALY for CDR vs $8760/QALY for ACDF). Sensitivity analysis revealed that CDR needed to survive at least 9.75 years to be considered a more cost-effective strategy than ACDF. Cervical disc replacement becomes an acceptable societal strategy as the prosthesis survival time approaches 11 years and the $50,000/QALY gained willingness-to-pay threshold is crossed. Sensitivity analysis also indicated that CDR must provide a utility state of at least 0.796 to be cost-effective.

Conclusions. Both CDR and ACDF were shown to be cost-effective procedures in the reference case. Results of the sensitivity analysis indicated that CDR must remain functional for at least 14 years to establish greater costeffectiveness than ACDF. Since the current literature has yet to demonstrate with certainty the actual durability and long-term functionality of CDR, future long-term studies are required to validate the present analysis.

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