Journal of Clinical Oncology, 2005 ASCO Annual Meeting Proceedings.
Vol 23, No 16S (June 1 Supplement), 2005: 721
© 2005 American Society of Clinical Oncology

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Abstract

Cost effectiveness of intravenous (IV) zoledronic acid vs other IV bisphosphonates for the prevention of bone complications in breast cancer patients with bone metastases: A Markov model from the UK perspective

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

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Background: IV bisphosphonate agents are effective in reducing skeletal related events (SREs) and alleviating bone pain in breast cancer patients with bone metastasis. However, these agents are characterized by different efficacy, administration time, and costs. We conducted an economic analysis to compare cost-effectiveness of these agents from the UK NHS perspective. Methods: A Markov model was developed to simulate survival and incidence of SREs for a hypothetical cohort of patients receiving no treatment (NT) or monthly injections of ibandronate (IBN), generic pamidronate (PA) or zoledronic acid (ZA). Probabilities of SREs (extrapolated from skeletal morbidity rates [SMR]) and mortality data were obtained from published clinical trials of each agent. Costs of drugs and their infusion, cost of SREs, and utility values were estimated from published sources. Utilities were applied to time with and without SREs to capture the impact on quality of life. Results: Based on relative reduction of risk of SREs (ratio of SMR of bisphosphonate therapy vs no therapy), the cumulative number of SREs over the lifetime of the patients was lowest for ZA (3.82 per patient), followed by PA (4.43), IBN (4.89), and NT (6.02). Total discounted costs (which included drug costs, infusion administration costs, and cost of treating SREs) were £2457 per patient lower for ZA than IBN, £1160 per patient than PA, and £556 per patient lower than NT. Survival was identical across all groups (25 months). However, discounted quality-adjusted life-years per patient was highest with ZA (0.822), followed by PA (0.816), IBN (0.812), and NT (0.773). ZA was less costly and more effective than all other therapies, and is therefore the economically preferred option. These findings were robust across various sensitivity analyses. Conclusions: Zoledronic acid appears to be the most cost-effective IV 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