Cost effectiveness of zoledronic acid in the management of skeletal metastases in hormone-refractory prostate cancer patients in France, Germany, Portugal, and the Netherlands.

Author(s): Carter JA, Joshi A, Kaura S, Botteman MF

Affiliation(s): Pharmerit International-Health Economics, Pharmerit North America LLC, 7272 Wisconsin Ave. #300, Bethesda, MD, USA. jcarter@pharmerit.com

Publication date & source: 2011, J Med Econ., 14(3):288-98. Epub 2011 Apr 6.

Publication type: Randomized Controlled Trial; Research Support, Non-U.S. Gov't

OBJECTIVE: Zoledronic acid (ZOL) reduces the risk of skeletal related events (SREs) in hormone-refractory prostate cancer (HRPC) patients with bone metastases. This study assessed the cost effectiveness of ZOL for SRE management in French, German, Portuguese, and Dutch HRPC patients. METHODS: This analysis was based on the results of a randomized phase III clinical trial wherein HRPC patients received up to 15 months of ZOL (n = 214) or placebo (n = 208). Clinical inputs were obtained from the trial. Costs were estimated using hospital tariffs, published, and internet sources. Quality adjusted life-years (QALYs) gained were estimated from a separate analysis of EQ-5D scores reported in the trial. Uncertainty surrounding outcomes was addressed via univariate sensitivity analyses. RESULTS: ZOL patients experienced an estimated 0.759 fewer SREs and gained an estimated 0.03566 QALYs versus placebo patients. ZOL was associated with reduced SRE-related costs [net costs] (-euro2396 [euro1284] in France, -euro2606 [euro841] in Germany, -euro3326 [euro309] in Portugal and -euro3617 [euro87] in the Netherlands). Costs per QALY ranged from euro2430 (Netherlands) to euro36,007 (France). CONCLUSIONS: This analysis is subject to the limitations of most cost-effectiveness analyses: it combines data from multiple sources. Nevertheless, the results strongly suggest that ZOL is cost effective versus placebo in French, German, Portuguese, and Dutch HRPC patients.