Cost-Effectiveness of Gleolan Guided Surgery Compared to Conventional White Light Surgery for High Grade Glioma

OBJECTIVES: To compare the cost per ‘imaging complete resection’ (ICR) with Gleolan (aminolevulinic acid HCl) oral solution (also known as 5-ALA) guided surgery in conjunction with blue light vs. conventional white light surgery in high grade glioma patients.

METHODS: Rate of ICR for Gleolan guided surgery vs. conventional white light surgery (64% vs. 38%) was retrieved from the Gleolan package insert. Cost of Gleolan was taken from First Data Bank at $2,998 per vial as of September 2022. Two vials were used in the analysis which accounts for patients with a body mass of up to 150kg and represents a higher than average expected additive Gleolan cost. EncoderPro was used to both reference average “base” payment rate and to calculate average “adjusted total” payment rate for 30 of the largest users of Gleolan, which is the actual payment made to hospitals as of September 2022. Ultimately the cost per ICR with Gleolan guided surgery vs. conventional white light surgery was calculated by dividing payment rate(s) and associated Gleolan cost by the associated percentage of ICR.

RESULTS: Cost per ICR with Gleolan guided surgery was 28% lower vs. conventional white light surgery ( $51,817 vs. $71,492) when using the average “base” payment rate. Costs per ICR with Gleolan guided surgery was 33% lower vs. conventional white light surgery ($ $79,026 vs. $ $117,318) when using the average “adjusted total” payment rate for 30 of the largest users of Gleolan.

CONCLUSIONS: Gleolan guided surgery demonstrated cost-effectiveness with the benefits of using Gleolan far outweighing the costs in all appropriate surgical patients where ICR is a goal of surgery. While Gleolan is additive to the cost of surgery, using Gleolan results in lower cost per ICR and therefore is a more efficient use of resources.