Cost-effectiveness of incorporating the MGMT methylation test in the public health service

Glioblastoma is the most prevalent tumor of the central nervous system in adults and has a poor prognosis. Hypermethylation of the 06-methylganine-DNA-methyltransferase (MGMT) promoter gene is a predictive factor for response to treatment with temozolomide plus radiotherapy, in addition, it is a prognostic factor for progression-free survival and overall survival.

Objective: To evaluate the cost-effectiveness of analyzing MGMT methylation in patients with Glioblastoma in the public health service in Brazil in November 2021.

Method: Survey the cost of research into MGMT methylation in Brazil, and temozolomide in the treatment of Glioblastoma.

Results and Discussion: The values for the MGMT methylation test varied between $176.43 and $772.74 depending on the laboratory researched and the method for carrying out the test. The price survey for the drug temozolomide on November 6, 2021 per tablet according to the dosage, between 5mg, 20mg, 100mg and 140mg ranged between $1.84 and $130.68. Considering a methylation rate of 45% and that in Brazil it is estimated 3840 methylated people/year. Based on a dose of 75mg/m2 per day for 30 days during radiotherapy and maintenance with 200 mg/m2/day, 5/28 days X 6 cycles. The average cost of treatment with individual temozolomide is $9920.99, totaling a global cost of $84,645,919.50, if all Glioblastoma patients are treated without the test. Considering that the average cost of the exam is $562.80, the investment is $4,801,872.54, generating a surplus to the public coffers of $41,747,430.50, without generating losses in the treatment of non-methylated patients, which has no indication of temozolomide.

Conclusion: Routinely carrying out MGMT Methylation research is cost-effective in patients in the public health service in Brazil.

Corresponding author: Karen Kristine Neuhauser (e-mail: karen_neuhauser@hotmail.com).