AI Article Synopsis
- Denosumab was found to be more effective than zoledronic acid in preventing skeletal-related events (SREs) in patients with bone-metastatic prostate cancer, showing a reduction in SREs and an increase in quality-adjusted life-years (QALYs), but it incurred higher overall costs.
- A Markov model was used to analyze the cost-effectiveness, revealing that while denosumab led to fewer SRE-related costs, it also had higher drug-related expenses, resulting in a high cost per QALY estimate of $1,058,741.
- The findings suggest that denosumab may not represent good value for money in the US healthcare context, highlighting the need for further evaluation of its pharmacoeconomic value
Article Abstract
Objective: Denosumab has been approved in the US for skeletal-related event (SRE) prevention in bone-metastatic prostate cancer on the basis of a phase III clinical trial in which denosumab reduced SREs relative to zoledronic acid. Overall survival, disease progression, and serious adverse events did not differ significantly between groups. This analysis assessed the cost-effectiveness of denosumab vs zoledronic acid in bone-metastatic prostate cancer from a US payer perspective.
Methods: A literature-based Markov model, wherein inputs were selected to reproduce clinical trial outcomes, was developed to estimate the survival, quality-adjusted life-years (QALYs), number and costs of SREs, and drug and administration costs for patients receiving denosumab or zoledronic acid over 27 months. QALYs were estimated by assigning health-state utilities. SRE-related costs and utilities were literature-based. Outcomes were discounted 3% per annum, and model robustness was tested via scenario, univariate, and probabilistic sensitivity analyses.
Results: Denosumab resulted in fewer estimated SREs (-0.241; 1.036 vs 1.277), more QALYs (0.0074; 0.9306 vs 0.9232), and lower SRE-related costs (-$2340; $8824 vs $11,164), but higher drug-related costs ($10,181; $23,144 vs $12,963) and total costs ($7841; $31,968 vs $24,127) vs zoledronic acid. The base case estimated cost per QALY-gained was $1,058,741.
Conclusion: This analysis was limited by the restricted availability of clinical data and the need to use projection methods beyond the trial time frame. However, a wide range of scenarios predicted denosumab to have an incremental cost/QALY gained above what may be considered acceptable value for money in the US. This raises important questions regarding the pharmacoeconomic value of denosumab in bone-metastatic prostate cancer.
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| http://dx.doi.org/10.3111/13696998.2012.719054 | DOI Listing |
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