Cost per patient and potential budget implications of denosumab compared with zoledronic acid in adults with bone metastases from solid tumours who are at risk of skeletal-related events: an analysis for Austria, Sweden and Switzerland

Abstract

ObjectivesTo assess cost implications per patient, per year, and to predict the potential annual budget impact when patients with bone metastases secondary to solid tumours at risk of skeletal-related events (SREs) transition from zoledronic acid (ZA; 4 mg every 3–4 weeks) to denosumab (120 mg every 4 weeks) in Austria, Sweden and Switzerland.MethodsCountry specific costs for medication and administration, patient management and SREs (defined as pathologic fracture, radiation to bone, surgery to bone and spinal cord compression) were assessed over a 1-year time horizon. Drug administration and patient management costs were taken from available public sources. SRE costs were based on local unit costs applied to country specific healthcare resources obtained from a multinational retrospective chart review study. Due to lack of real world data for the included countries, SRE rates were derived from phase III clinical trials in patients with advanced cancer and bone metastases. These trials demonstrated that denosumab was superior to ZA in the reduction of SREs.ResultsEstimated total annual cost savings for each patient transitioned from ZA to denosumab varied by country and cancer type, ranging from €1583 to €2375 in Austria, from €1980 to €2319 in Sweden (9.1 SEK/€) and from €3408 to €3857 in Switzerland (1.2 CHF/€). Cost savings were mainly driven by the lower SRE related costs and lower administration costs of denosumab compared with ZA.ConclusionsDenosumab offers superior efficacy compared with ZA in patients with solid tumours and bone metastases. Cost savings are predicted in the Austrian, Swedish and Swiss healthcare systems following treatment transition from ZA to denosumab.

A cost-effectiveness analysis of denosumab for the prevention of skeletal-related events in patients with multiple myeloma in four European countries: Austria, Belgium, Greece, and Italy

“…Because patient and disease characteristics, treatment approaches and effects, and economic model structures and assumptions are different across studies, it is difficult to compare our results directly with published cost-effectiveness studies evaluating denosumab in either the US healthcare setting 31 , or in patients with bone metastases from solid tumors 33,40,[71][72][73][74][75][76][77][78][79][80][81] . There were three main differences between our model and the one used by Raje et al 31 in the US: (1) anti-MM treatment costs were included as a scenario analysis, but not in the base case; (2) the main comparator for denosumab was ZA, with a scenario analysis with no treatment as the comparator (a weighted average of the two was used by Raje et al 31 ); and (3) we limited the analysis to the payer perspective only.…”

Hospitalizations for fracture in patients with metastatic disease: primary source lesions in the United States

“…Two classes of medications, the RANK-ligand inhibitors and bisphosphonates, reduce the number of skeletal events, such as pathologic fracture, in patients with metastatic disease to bone. [23][24][25][26] However, most of those studies focused on the 3 most common carcinomas (breast, lung, and prostate) to metastasize to bone and cause pathologic fracture. ere is greater variability in the prophylactic treatment of other forms of cancer that have metastasized to bone amongst oncologists.…”

Therapeutic Potential of Denosumab in Patients With Lung Cancer: Beyond Prevention of Skeletal Complications

“…Most pharmacoeconomic evaluations published between 2011 and 2013 in lung cancer patients or in solid tumor patients (including lung cancer) suggest that, despite its higher cost compared with zoledronic acid, denosumab is cost-effective for the health care system when SRE-related costs and administration costs (Table 3). 40,44,[55][56][57][58][59][60] An independent economic evaluation 59 concluded that, with the patient access scheme, denosumab is costeffective relative to zoledronic acid but not to best supportive care. However, because of between-country variation in net drug prices of the 2 drugs it is not possible to reach a general conclusion about this question.…”