Economic Evaluation of Denosumab Compared with Zoledronic Acid in Hormone-Refractory Prostate Cancer Patients with Bone Metastases

Abstract

• Bone metastases are prevalent in patients with hormone-refractory prostate cancer and are associated with substantial economic burden in the United States ($1.9 billion in 2004).• Skeletal-related events (SREs) are frequently seen in hormonerefractory prostate cancer patients with bone metastases. Lage et al. (2008) found that approximately one-half of patients with hormone-refractory prostate cancer and bone metastases in their study sample had at least 1 SRE. SREs are associated with increased health care costs and decreased quality of life.• Reed et al. (2004) showed that compared with placebo, zoledronic acid was associated with an incremental cost per SRE avoided of $12,300 and cost per quality-adjusted life year of In a study of autopsies of patients with prostate cancer, 65%-75% had bone metastases. Bone metastases place a substantial economic burden on payers with estimated total annual costs of $1.9 billion in the United States. Skeletal-related events (SREs), including pathologic fractures, spinal cord compression, surgery to bone, and radiation to bone, affect approximately 50% of patients with bone metastases. They are associated with a decreased quality of life and increased health care costs. Zoledronic acid is an effective treatment in preventing SREs in solid tumors and multiple myeloma. Recently, denosumab was FDA-approved for prevention of SREs in patients with bone metastases from solid tumors. A Phase 3 clinical trial (NCT00321620) demonstrated that denosumab had superior efficacy in delaying first and subsequent SREs compared with zoledronic acid. However, the economic value of denosumab has not been assessed in patients with hormone-refractory prostate cancer.

Systematic review of the clinical effectiveness and cost-effectiveness, and economic evaluation, of denosumab for the treatment of bone metastases from solid tumours

“…Xie and colleagues 185 (supported by Novartis) estimate the cost-effectiveness of denosumab compared with zoledronic acid for patients with hormone refractory prostate cancer with bone metastases. This uses a 1-year Markov model with a 13-week cycle.…”

Efficacy and Safety of Denosumab for the Treatment of Bone Metastases in Patients with Advanced Cancer

“…The simpler administration method of denosumab could be an advantage in the USA and also in Japan. Although the direct cost of denosumab is higher than zoledronic acid for patients with bone metastases (27) ( Table 2), in assessments including prolongation of the time to SREs, a cost-effectiveness study performed in the USA reported that denosumab is more cost-effective than zoledronic acid (28). Therefore, the standard medical treatment for bone metastases is expected to change from bisphosphonate preparations to denosumab in the future.…”

Cost-Effectiveness Analysis of Allopurinol Versus Febuxostat in Chronic Gout Patients: A U.S. Payer Perspective

“…26,32 Data from the long-term extension study demonstrated that maintenance of sUA goals will lead to virtual elimination of acute gout flares and resolution of tophi status. 5 These data demonstrate the significance of long-term management of sUA target goals that can lead to prevention and near elimination of acute gout flares and resolution of tophus status over time.…”