HIGH-GRADE ASTROCYTOMAS - RESOURCE USE, CLINICAL OUTCOMES, AND COST OF CARE

Objective: To describe the clinical course, survival, resource use, an d direct medical costs of care for patients with high-grade astrocytom as. Material and Methods: All patients with grade 3 or 4 astrocytoma w ho resided in Olmsted County, Minnesota, or one of the six adjacent co unties and had a tissue diagnosis first made between 1987 and 1992 wer e studied. Clinical characteristics, initial management, use of resour ces, clinical course, survival, and medical charges were analyzed. Res ults: Sixty-four patients, with a mean age of 62 years, were identifie d; 81% had glioblastoma multiforme. Approximately 60% underwent surgic al resection, 80% had radiotherapy, and 50% had chemotherapy for initi al management. After initial treatment (median duration, 116 days), ap proximately 75% of patients had a course with stable disease (median d uration, 198 days), The overall median duration of survival was 323 da ys; lower grade and younger age were significantly associated with lon ger median survival-for example, 1,493 days for patients younger than 65 years with grade 3 astrocytomas and 205 days for patients 65 gears old or older with grade 4 astrocytomas. The mean total direct medical charges were $67,887. Conclusion: In most patients with high-grade ast rocytomas, a substantial period elapsed before disease progressed. Alt hough the overall median duration of survival was less than I year, yo unger patients, especially those with grade 3 astrocytomas, had a long er survival. The management of patients with high-grade astrocytomas u ses substantial health-care resources.