Journal of Clinical Oncology, 2005 ASCO Annual Meeting Proceedings.
Vol 23, No 16S (June 1 Supplement), 2005: 664
© 2005 American Society of Clinical Oncology

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Abstract

A Markov model to evaluate the cost effectiveness of intravenous (IV) zoledronic acid vs IV generic pamidronate or oral ibandronate in the prevention of bone complications in breast cancer patients with bone metastases

PharMerit North America, Bethesda, MD; Clin de Genolier, Genolier, Switzerland; Univ of Southern CA, Los Angeles, CA; Novartis Pharm Corp, East Hanover, NJ

664

Background: Bisphosphonates are commonly used to reduce the burden of skeletal related events [SREs] and bone pain in breast cancer patients with bone metastasis. These agents are characterized by different efficacy, safety, dosage form, time of administration, compliance, and acquisition costs. We assessed the cost effectiveness of commonly-used bisphosphonate therapies from the perspective of the UK NHS. Methods: We developed a Markov model to simulate the incidence of SREs, cost of care, survival and quality-adjusted life years (QALYs) for a hypothetical cohort of patients receiving no treatment (NT), daily oral ibandronate (OI), or monthly injections of generic pamidronate (PA) or zoledronic acid (ZA). This literature-based model includes assumptions about skeletal morbidity rates (SMR, directly obtained or extrapolated from placebo-controlled clinical trials), mortality, costs of drug (including infusion cost), cost of SRE, utility values for time with and without SREs and relief from bone pain, and compliance with therapy. Results: Based on relative reductions of risk of SREs (ratio of SMR of bisphosphonate therapy vs no therapy) and compliance with therapy, the cumulative number of SREs over the lifetime of a patient was projected to be lowest for ZA (3.82 per patient), followed by PA (4.43), OI (4.91), and NT (6.02). Total discounted costs (which included drug costs, infusion administration costs, and cost of treating SREs) were £1949 per patient lower for ZA than OI, £1160 per patient lower than PA, and £556 per patient lower than NT. Survival was identical across all groups (25 months). However, discounted QALYs per patient were highest with ZA (0.822), followed by PA (0.816), OI (0.812), and NT (0.773). ZA was therefore less expensive and more effective than all other options. These findings were robust across various sensitivity analyses. Conclusions: For breast cancer patients with bone metastasis, zoledronic acid appears to be the most cost-effective bisphosphonate therapy and is also highly cost effective compared to no therapy.

Author Disclosure

Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Novartis Novartis, Roche Novartis, Roche Novartis, Roche

Abstract presentation from the 2005 ASCO Annual Meeting