Evaluating the Cost-Effectiveness of Tumor-Treating Fields in Combination With Temozolomide for Glioblastoma in Singapore
Author(s)
Jorge F. Nino de Rivera Guzman, MSc1, Michelle Yeo, MSc2, Bruce Wang, PhD3.
1Health Economy specialist, Novocure, Glendale, CO, USA, 2Novocure, Singapore, Singapore, 3Novocure, Portsmouth, NH, USA.
1Health Economy specialist, Novocure, Glendale, CO, USA, 2Novocure, Singapore, Singapore, 3Novocure, Portsmouth, NH, USA.
OBJECTIVES: Tumor-Treating Fields (TTFields) improve survival outcomes when combined with temozolomide (TMZ) in glioblastoma (GBM) patients. The EF-14 trial reported TTFields + TMZ achieved a median progression-free survival (PFS) of 6.7 months versus 4 months (HR 0.63; 95% CI, 0.52-0.76; P<.001) and overall survival (OS) of 20.9 months versus 16 months (HR 0.63; 95% CI, 0.53-0.76, P<.001) with TMZ alone. This analysis evaluates the cost-effectiveness of adding TTFields to TMZ from the perspective of the Singapore healthcare payer.
METHODS: A partitioned survival model assessed TTFields + TMZ versus TMZ monotherapy in newly diagnosed GBM over 40 years. Health states included PFS, progressive disease, and death. OS was modeled using a 3-phase approach based on literature: (1) EF-14 Kaplan-Meier data (≤5 years), (2) epidemiological conditional survival (years 5-15), and (3) background mortality (≥15 years). PFS was extrapolated using Weibull distribution. Clinical inputs came from EF-14 trial data, while local cost inputs were sourced from the Singapore Healthcare Resource Sheet. Utility values were obtained from published literature. Costs and outcomes were discounted by 3% annually. Sensitivity analyses were conducted to assess the robustness of the model.
RESULTS: TTFields + TMZ increased survival by 1.23 life years and 0.94 quality-adjusted life years versus TMZ monotherapy, with an incremental cost of SGD 246,240. One-way sensitivity analysis identified TTFields treatment duration and utility values as key cost-effectiveness drivers.
CONCLUSIONS: TTFields + TMZ offers meaningful survival and quality-of-life benefits for GBM patients. Its clinical value and potential impact on patient outcomes are key considerations for healthcare decision-making in Singapore. Under current pricing assumptions, the ICER falls within the 2-3 times GDP per capita threshold commonly used by the WHO, supporting its cost-effectiveness framework. These findings highlight TTFields’ value in GBM care and its potential to enhance patient outcomes, reinforcing the need for innovative access in Singapore’s healthcare system.
METHODS: A partitioned survival model assessed TTFields + TMZ versus TMZ monotherapy in newly diagnosed GBM over 40 years. Health states included PFS, progressive disease, and death. OS was modeled using a 3-phase approach based on literature: (1) EF-14 Kaplan-Meier data (≤5 years), (2) epidemiological conditional survival (years 5-15), and (3) background mortality (≥15 years). PFS was extrapolated using Weibull distribution. Clinical inputs came from EF-14 trial data, while local cost inputs were sourced from the Singapore Healthcare Resource Sheet. Utility values were obtained from published literature. Costs and outcomes were discounted by 3% annually. Sensitivity analyses were conducted to assess the robustness of the model.
RESULTS: TTFields + TMZ increased survival by 1.23 life years and 0.94 quality-adjusted life years versus TMZ monotherapy, with an incremental cost of SGD 246,240. One-way sensitivity analysis identified TTFields treatment duration and utility values as key cost-effectiveness drivers.
CONCLUSIONS: TTFields + TMZ offers meaningful survival and quality-of-life benefits for GBM patients. Its clinical value and potential impact on patient outcomes are key considerations for healthcare decision-making in Singapore. Under current pricing assumptions, the ICER falls within the 2-3 times GDP per capita threshold commonly used by the WHO, supporting its cost-effectiveness framework. These findings highlight TTFields’ value in GBM care and its potential to enhance patient outcomes, reinforcing the need for innovative access in Singapore’s healthcare system.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD252
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Oncology