Cost‐effectiveness of zoledronic acid and strontium‐89 as bone protecting treatments in addition to chemotherapy in patients with metastatic castrate‐refractory prostate cancer: results from theTRAPEZEtrial (ISRCTN12808747)

Abstract

ObjectiveTo evaluate the cost-effectiveness of adding zoledronic acid or strontium-89 to standard docetaxel chemotherapy for patients with castrate-refractory prostate cancer (CRPC). Patients and methodsData on resource use and quality of life for 707 patients collected prospectively in the TRAPEZE 2 9 2 factorial randomised trial (ISRCTN 12808747) were used to assess the cost-effectiveness of i) zoledronic acid versus no zoledronic acid (ZA vs. no ZA), and ii) strontium-89 versus no strontium-89 (Sr89 vs. no Sr89). Costs were estimated from the perspective of the National Health Service in the UK and included expenditures for trial treatments, concomitant medications, and use of related hospital and primary care services. Quality-adjusted life-years (QALYs) were calculated according to patients' responses to the generic EuroQol EQ-5D-3L instrument, which evaluates health status. Results are expressed as incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves. ResultsThe per-patient cost for ZA was £12 667, £251 higher than the equivalent cost in the no ZA group. Patients in the ZA group had on average 0.03 QALYs more than their counterparts in no ZA group. The ICER for this comparison was £8 005. Sr89 was associated with a cost of £13 230, £1365 higher than no Sr89, and a gain of 0.08 QALYs compared to no Sr89. The ICER for Sr89 was £16 884. The probabilities of ZA and Sr89 being costeffective were 0.64 and 0.60, respectively.

Cost-Effectiveness of Treatments for the Management of Bone Metastases: A Systematic Literature Review

“…Twenty of the identified studies [18, 19, 22-29, 31, 32, 34-41] focus on a single country, while four studies report results for more than one country [20,21,30,33]. Of the studies focusing on a single country, ten were conducted in Europe (seven in the UK [18,19,23,24,26,29,34] and one in each of Greece [41], the Netherlands [38] and Switzerland [27]), nine in North America (seven in the United States [28, 31, 35-37, 39, 40], two in Canada [25,32]) and one in New Zealand [22]. Among studies reporting results for more than one country, three [20,21,30] had a focus on a small number of European countries, while one study pooled information from 17 countries, including Argentina, Australia, Brazil, Italy and Sweden [33].…”

“…evidence published in the literature, estimates drawn from patient-level data, expert opinion and other secondary sources) through some form of a decision analytic structure. The remaining six studies [18,27,29,32,33,38] involved using statistical methods to analyse patient-level data collected from a single clinical trial (most often randomised clinical trials (RCTs)).…”

“…A time horizon that is long enough to capture all the costs and benefits is typically recommended [42,43] though, in the reviewed studies, this was often dictated by the follow-up period in clinical studies which provided data for the economic evaluations. One study reported results over time horizon shorter than 12 months [27], eight studies [19-21, 23, 24, 33, 39, 40] looked at costs and benefits accruing between 12 and 24 months, eight studies reported results over time horizons equal to or longer than 24 months [18,19,28,29,31,[34][35][36], while four studies [22,30,32,37] produced results over a lifetime horizon. One study analysed costs and benefits accruing over different lengths of time [38], while in another study, by Yfantopoulos and colleagues [41], the length of time horizon varied according to the type of primary cancer investigated.…”

“…outpatient appointments, hospitalisation for skeletal related events). In eight studies [18,19,22,28,29,33,34,38], costs extended to use of primary and community care services. Figure 4 shows the split between studies in terms of key outcomes reported.…”

TRAPEZE: a randomised controlled trial of the clinical effectiveness and cost-effectiveness of chemotherapy with zoledronic acid, strontium-89, or both, in men with bony metastatic castration-refractory prostate cancer

“…Reproduced and amended with permission from Andronis et al 55 In the source figure, only the ZA CEAC was plotted; a CEAC for No ZA has been added here.…”