The cost of treating adult glioblastoma patients in England (2013-2018) – BNOS

I have just given a talk about our work at the BNOS conference in Liverpool, and thought I should write something about the work we have been doing.

The GlioCova project has data on the patient demographics, tumour demographics, and the treatments received (chemotherapy, radiotherapy, and neurosurgery) of 50,000+ adult patients diagnosed with a primary brain tumour between 2013-2018. We specifically have information on the inpatient and outpatient NHS admissions in HES tables of these patients from 3 months before diagnosis (the end of 2012) and follow-up data after diagnosis (up to the end of 2019). Using this rich and detailed patient-level dataset as well as software publicly available from the NHS (HRG4+ Reference Costs Grouper), we provided comprehensive up-to-date estimations of the secondary care costs of cranial glioblastoma patients. My work was the first attempt to estimate the treatment and care costs of the commonest primary malignant brain tumour in a multi-year whole population cohort in England.

Glioblastoma tumours (WHO grade IV) are the most common primary malignant brain tumour overall, with a 2-year survival of around 25% and a 5-year survival of just below 5%. Given the poor prognosis for glioblastoma patients, questions about their treatment and care costs are important. In a publicly funded healthcare system such as the NHS, it is important for us to understand where and how public money is spent. Understanding costs can also enable future calculations of the cost-effectiveness of treatments and deciding on service configurations; providing insight into economic data can help plan new services and treatments by defining potential value and scoping the extent of strategies that may be cost-saving. Finally, it has been stated by a UK governmental assessment that the influence of diseases on the economy can help define health research priorities. Therefore, providing estimations of costs for these patients may be used as an economic argument to increase research priorities.

15,277 patients were diagnosed with a cranial glioblastoma between 2013-2018, and most of these patients had inpatient and outpatient care (98% and 95% respectively). We found that for our study period – the last 3 months of 2012 and up to the end of 2019 – total secondary cost estimations were over £414 million (>£321.3 million for inpatient care and >£92.8 million for outpatient care). Notably, only a third of the total cost was attributed to direct treatment. A common theme following treatment emerges: patients suffer from the side-effects of these treatments which may lead to complications and morbidities. Side effects may also arise due to tumour location itself: glioblastomas have a significant effect on patients since they directly impact patient personality, speech, physical functions, and seizure thresholds, which may incur additional costs for the NHS other than direct cancer treatment.

I did this work as part of my MRes project rotation for the Imperial College Cancer Informatics course at the Computational Oncology Lab Group. It was my first conference, and I was excited, and nervous, but enjoyed every minute of it. I am currently working on publishing a paper on the comparative costs of glioblastoma and meningioma using GlioCova data. As this is an ongoing project, for our future work, we hope to extend the cost analysis to the wider scope of the primary brain tumour cohort. A comparative analysis of the estimations of costs and care pathways of different brain tumours would be feasible. We also hope to identify patient characteristics and variables that drive the total cost per patient which may provide interventions and suggestions to reduce the economic burden of disease.

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