Objectives:To undertake an economic evaluation of denosumab in comparison with a mixed scenario consisted of zoledronic acid or no treatment if there is a contraindication to this agent due to severe renal impairment (Mix ZA/No tx) in patients with multiple myeloma (MM). Methods: The analysis adopted the perspective of the Mexican public health care system as a payer. This is a partitioned-survival five-stages semi-Markov model for a life-time horizon. We evaluated the frequencies of skeletal-related events (SREs) as well as the costs associated to drug acquisition/infusion, routine patient management, medical attention of SREs, treatment of serious adverse events, and anti-myeloma treatment. Results: Denosumab use was more expensive but also more effective, with incremental cost-effectiveness ratios of $13,942 Mexican pesos (MXN) per SRE avoided and $1,893 MXN per additional month of progression-free survival. In general, the model is robust. Conclusions: In patients with MM, denosumab represents a cost-effective intervention in comparison with the Mix ZA/No tx.

Objetivo: Evaluar económicamente el denosumab en comparación con un escenario mixto de ácido zoledrónico o no tratamiento si existe contraindicación a dicho agente por enfermedad renal grave (Mix AZ/No Trt) en pacientes con tumores sólidos (TS) con metástasis ósea. Método: Análisis de costo-efectividad basado en un modelo Markov, con horizonte temporal de por vida y bajo perspectiva del Instituto Mexicano del Seguro Social. Se evaluaron las frecuencias de eventos relacionados con esqueleto (ERE) y los costos asociados con adquisición de medicamentos, infusión de AZ, manejo de rutina, atención de ERE y tratamiento de eventos adversos serios. Resultados: En el caso base, denosumab resultó dominante sobre Mix AZ/No Trt, con ahorro promedio de $2,494 pesos y 0.781 ERE evitados por paciente. Si AZ se administra cada 12 semanas, denosumab no sería dominante, pero sí costo-efectivo. El denosumab fue dominante o costo-efectivo en 74.7% de las simulaciones. Conclusiones: En pacientes con TS con metástasis ósea, denosumab representa una intervención dominante o al menos costo-efectiva frente al Mix AZ/No Trt.

Objective: To evaluate denosumab economically compared with a mixed scenario of zoledronic acid or no treatment if there is contraindication to such agent due to severe kidney impairment (Mix ZA/No Trt) in patients with solid tumors (ST) with bone metastasis. Method: It is a cost-effectiveness analysis based on a Markov model with a lifetime horizon, under the IMSS perspective. We evaluated the frequencies of skeletal-related events (SRE) as well as the costs associated to drug acquisition, intravenous infusion of ZA, routine patient management, medical attention of SRE, and treatment of serious adverse events. Results: In the base-case, denosumab resulted dominant over Mix ZA/No Trt, with mean savings of $2,494 Mexican pesos and 0.781 SRE avoided per patient. If ZA is given every 12 weeks, denosumab would not be dominant, but cost-effective. Denosumab was either dominant or cost-effective in 74.7% of the simulations. Conclusions: In patients with ST with bone metastasis, denosumab represents a dominant or at least a cost-effective intervention in comparison with Mix ZA/No Trt.

Objectives:To undertake an economic evaluation of denosumab in comparison with a mixed scenario consisted of zoledronic acid or no treatment if there is a contraindication to this agent due to severe renal impairment (Mix ZA/No tx) in patients with multiple myeloma (MM). Methods: The analysis adopted the perspective of the Mexican public health care system as a payer. This is a partitioned-survival five-stages semi-Markov model for a life-time horizon. We evaluated the frequencies of skeletal-related events (SREs) as well as the costs associated to drug acquisition/infusion, routine patient management, medical attention of SREs, treatment of serious adverse events, and anti-myeloma treatment. Results: Denosumab use was more expensive but also more effective, with incremental cost-effectiveness ratios of $13,942 Mexican pesos (MXN) per SRE avoided and $1,893 MXN per additional month of progression-free survival. In general, the model is robust. Conclusions: In patients with MM, denosumab represents a cost-effective intervention in comparison with the Mix ZA/No tx.