Cost-effectiveness of denosumab vs zoledronic acid for prevention of skeletal-related events in patients with solid tumors and bone metastases in the United States

Alison T Stopeck, Michael Rader, David Henry, Mark Danese, Marc Halperin, Ze Cong, Yi Qian, Roger Dansey, Karen Chung

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Objective: With increasing healthcare resource constraints, it has become important to understand the incremental cost-effectiveness of new medicines. Subcutaneous denosumab is superior to intravenous zoledronic acid (ZA) for the prevention of skeletal-related events (SREs) in patients with advanced solid tumors and bone metastases. This study sought to determine the lifetime cost-effectiveness of denosumab vs ZA in this setting, from a US managed-care perspective. Methods: A lifetime Markov model was developed, with relative rate reductions in SREs for denosumab vs ZA derived from three pivotal Phase 3 trials involving patients with castration-resistant prostate cancer (CRPC), breast cancer, and non-small-cell lung cancer (NSCLC), and bone metastases. The real-world SRE rates in ZA-treated patients were derived from a large commercial database. SRE and treatment administration quality-adjusted life year (QALY) decrements were estimated with time-trade-off studies. SRE costs were estimated from a nationally representative commercial claims database. Drug, drug administration, and renal monitoring costs were included. Costs and QALYs were discounted at 3 annually. One-way and probabilistic sensitivity analyses were conducted. Results: Across tumor types, denosumab was associated with a reduced number of SREs, increased QALYs, and increased lifetime total costs vs ZA. The costs per QALY gained for denosumab vs ZA in CRPC, breast cancer, and NSCLC were $49,405, $78,915, and $67,931, respectively, commonly considered good value in the US. Costs per SRE avoided were $8567, $13,557, and $10,513, respectively. Results were sensitive to drug costs and SRE rates. Limitations: Differences in pain severity and analgesic use favoring denosumab over ZA were not captured. Mortality was extrapolated from fitted generalized gamma function beyond the trial duration. Conclusion: Denosumab is a cost-effective treatment option for the prevention of SREs in patients with advanced solid tumors and bone metastases compared to ZA. The overall value of denosumab is based on superior efficacy, favorable safety, and more efficient administration.

Original languageEnglish (US)
Pages (from-to)712-723
Number of pages12
JournalJournal of Medical Economics
Volume15
Issue number4
DOIs
StatePublished - Aug 2012

Fingerprint

zoledronic acid
Cost-Benefit Analysis
Neoplasm Metastasis
Bone and Bones
Quality-Adjusted Life Years
Costs and Cost Analysis
Neoplasms
Breast Neoplasms
Castration
Non-Small Cell Lung Carcinoma
Prostatic Neoplasms
Databases
Bone Neoplasms
Drug Costs
Denosumab
Managed Care Programs
Pharmaceutical Preparations
Health Care Costs

Keywords

  • Bone metastases
  • Cost-effectiveness
  • Denosumab
  • Skeletal-related events
  • Solid tumors
  • Zoledronic acid

ASJC Scopus subject areas

  • Health Policy

Cite this

Cost-effectiveness of denosumab vs zoledronic acid for prevention of skeletal-related events in patients with solid tumors and bone metastases in the United States. / Stopeck, Alison T; Rader, Michael; Henry, David; Danese, Mark; Halperin, Marc; Cong, Ze; Qian, Yi; Dansey, Roger; Chung, Karen.

In: Journal of Medical Economics, Vol. 15, No. 4, 08.2012, p. 712-723.

Research output: Contribution to journalArticle

Stopeck, Alison T ; Rader, Michael ; Henry, David ; Danese, Mark ; Halperin, Marc ; Cong, Ze ; Qian, Yi ; Dansey, Roger ; Chung, Karen. / Cost-effectiveness of denosumab vs zoledronic acid for prevention of skeletal-related events in patients with solid tumors and bone metastases in the United States. In: Journal of Medical Economics. 2012 ; Vol. 15, No. 4. pp. 712-723.
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AU - Danese, Mark

AU - Halperin, Marc

AU - Cong, Ze

AU - Qian, Yi

AU - Dansey, Roger

AU - Chung, Karen

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N2 - Objective: With increasing healthcare resource constraints, it has become important to understand the incremental cost-effectiveness of new medicines. Subcutaneous denosumab is superior to intravenous zoledronic acid (ZA) for the prevention of skeletal-related events (SREs) in patients with advanced solid tumors and bone metastases. This study sought to determine the lifetime cost-effectiveness of denosumab vs ZA in this setting, from a US managed-care perspective. Methods: A lifetime Markov model was developed, with relative rate reductions in SREs for denosumab vs ZA derived from three pivotal Phase 3 trials involving patients with castration-resistant prostate cancer (CRPC), breast cancer, and non-small-cell lung cancer (NSCLC), and bone metastases. The real-world SRE rates in ZA-treated patients were derived from a large commercial database. SRE and treatment administration quality-adjusted life year (QALY) decrements were estimated with time-trade-off studies. SRE costs were estimated from a nationally representative commercial claims database. Drug, drug administration, and renal monitoring costs were included. Costs and QALYs were discounted at 3 annually. One-way and probabilistic sensitivity analyses were conducted. Results: Across tumor types, denosumab was associated with a reduced number of SREs, increased QALYs, and increased lifetime total costs vs ZA. The costs per QALY gained for denosumab vs ZA in CRPC, breast cancer, and NSCLC were $49,405, $78,915, and $67,931, respectively, commonly considered good value in the US. Costs per SRE avoided were $8567, $13,557, and $10,513, respectively. Results were sensitive to drug costs and SRE rates. Limitations: Differences in pain severity and analgesic use favoring denosumab over ZA were not captured. Mortality was extrapolated from fitted generalized gamma function beyond the trial duration. Conclusion: Denosumab is a cost-effective treatment option for the prevention of SREs in patients with advanced solid tumors and bone metastases compared to ZA. The overall value of denosumab is based on superior efficacy, favorable safety, and more efficient administration.

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