Table 1.

Estimated Direct Costs of Brain Cancer for the Most Frequently Evaluated Components of Total Direct Costs

Study (Country)	Data Source	Sample Size	Study Period	Cost Calculation Methods	Costs of Surgery, RT, Outpatient Drugs*	Overall Cost*
Joahnnesen et al17 (Norway)†	National data sources	171	1985-1999	Estimated primary treatment costs for patients with glioblastoma with three treatment options	Surgery: N/A; RT: $25,618 ($32,665.73); outpatient drugs: N/A	Total average cost per patient: $25,618 ($32,665.73) for RT, $23,442 ($29,891.09) for accelerated RT, $14,534 ($18,532.43) for intracavitary brachytherapy
Silverstein12 (United States)†	Cost data taken from Rochester Epidemiology Project and Olmstead County Utilization Study; clinical data from chart reviews at the Mayo Clinic	64	1987-1992	An all-payer perspective was used. Medical charges were used to estimate direct medical costs of treatment.	Surgery: $7,514 ($10,985.67); RT: $9,610 ($14,050); outpatient drugs: N/A	Total cost per patient: $67,887 ($99,252.61)
Latif15 (United Kingdom)†	Patient data from the Department of Clinical Neurosciences at Western General Hospital, Edinburgh	236	1989-1995	Median cost per patient was calculated, followed by median cost of each week survival. Amounts calculated using unit costing according to NHS National Costing Project	Surgery: N/A; RT: $28,494 ($40,099.97); outpatient drugs: N/A	N/A
Mehta38 (United States)†	Computerized billing forms for patients treated at University of Wisconsin	635	1989-1994	Costing analysis for estimated average costs	Surgery: $13,729-$27,523 for those receiving radiation and surgery ($19,621.95 to $39,336.80); RT: $16,250 ($23,225.05); outpatient drugs: N/A	Average cost per week of survival: $310 ($443.06) for RT, $524 ($748.92) for resection plus radiation, and $270 ($385.89) for radiosurgery plus radiation
Polinsky et al13 (United States)†	Costs of patients treated in a hospital in Ann Arbor, MI	29	1990-1995	Average costs calculated for patients undergoing craniotomy or stereotactic craniotomy Cost was calculated by addition of hospital charges	Surgery: N/A; RT: N/A; outpatient drugs: N/A	Average costs for craniotomy: $11,365 ($16,243); stereotactic craniotomy: $8,495 ($12,141.34)
Blomqvist et al16,45 (Sweden)†	National data sources	Swedish population	1996	Nationwide costs of ambulatory, in hospital, long term and palliative/terminal care, drug consumption, temporary and long term morbidity	Surgery: N/A; RT: N/A; outpatient drugs: N/A	Average direct costs of care: $4,599 ($6,445); 71% of the costs, were for short-term hospital care, 19% for long-term hospital-based home care‡
Mendez14 (Canada)†	Utilization and clinical data gathered from records of patients treated at Queen Elizabeth II Health Sciences Centre in Nova Scotia	61	1996-1998	Unit cost data and patient-specific utilization from hospital records	Surgery: $7,957 ($10,306.45); RT combined with surgery: $12,175 ($15,769.89); outpatient drugs: $663 ($858.76)	Average total cost per patient: $11,446 ($14,580); 25% were RT costs, 16% were surgery costs, 7% were chemotherapy costs
Chang et al6 (United States)	Data source: Insurance claims of 3 million Americans	652	1998-2000	Cancer costs (seven types of cancer) in a retrospective study	Surgery: $365 ($486) per month, SD, $1,684 ($2,243); RT: $658 ($877) per month, SD, $1436 ($1,913); outpatient drugs: $6 ($8) per month, SD, $38 ($51)	Mean total direct medical costs per patient per month $6,364 ($8,478)
Kutikova39 (United States)	Data source: MarketScan commercial claims and encounters and Medicare Supplemental and Medicare supplemental and Coordination of Benefits databases	653	1998-2000	Resource utilization and direct costs were summarized as monthly means and the total amount over the follow-up period	Surgery: N/A; RT: $645 ($713.59) per month outpatient; outpatient drugs: $249 ($275.48) per month	Total cost per patient $49,242 ($54,478.69)
Mabasa22 (Canada)	Prospective patient cost data; medical records for those in treatment in Canada	41	2001-2002	Overall survival, duration of therapy, drug cost, labor and supplies, and successive or prior chemotherapy	Surgery: N/A; RT: N/A; outpatient drugs: TMZ $7,430 ($8,454.28); lomustine $98 ($111.51)	Total cost per life-year gained: $32,247 ($36,692.48) to $162,186 ($184,544.50)

Abbreviations: N/A, not applicable; NHS, National Health Service; RT, radiotherapy; SD, standard deviation; TMZ, temozolomide

^*Values in parentheses represent 2012 inflation-adjusted costs in dollars.

^†Studies were conducted before TMZ received FDA marketing approval in the United States (August 1999), Medicines Control Agency approval in the United Kingdom (January 1999), and Health Canada approval (1999).

^‡We estimated the prevalence/incidence and per-person cost of brain cancer in 1997 using data from data provided by Blumqvst and the Swedish government.⁴⁵