A retrospective analysis of the cost effectiveness of treatment with Metastron?? (89Sr-chloride) in patients with prostate cancer metastatic to bone

Several phase III studies (Quilty et al, 1982;Lewington et al, 1991;McEwan et al, 1994;Malmberg et al, 1997) now support the usefulness and cost effectiveness of Sr-89 either as an alternative or an adjunct to external beam radiotherapy (EBRT) in men with bone pain due to metastatic prostate cancer. Primary study end points have included pain response presented in terms of reduction in severity and/or frequency of pain and/or analgesic use, delayed onset of new painful sites and/or decrease in EBRT requirement over the patient's remaining lifetime.It is recognized that the effects of palliative treatment extend beyond simply reducing the severity of a reference symptom, such as pain. Health-related QoL describes a multidimensional view of a patient's psychological and social, as well as physical wellbeing. Despite the frequent citing of the importance of overall QoL in men with metastatic prostate cancer and the potential impact that Sr-89 might have on QoL, there has been little attention paid to formal evaluation of QoL as a primary end-point in the study of Sr-89 to date.The Trans Canada Study Group (Porter et al, 1993) undertook a limited QoL evaluation and found that in the areas of physical mobility and pain control, Sr-89 produced a significant beneficial effect for men with metastatic prostate cancer. This assessment, as the authors acknowledge, was not ideal in that a standardized instrument was not used and conclusions were based on data pooled from a number of non-validated instruments including linear analogue self assessment scales, questionnaires and patient diaries.Following the establishment of a Government reimbursement in early 1995, Sr-89 therapy for the relief of bone pain due to prostate cancer became widely available in Australia. A group of interested Radiation Oncologists (the Australian Metastron User's Group) took this opportunity to initiate a prospective study to (1) confirm that treatment efficacy and toxicity were consistent with the world literature and to (2) simultaneously assess the nature and time course of any possible QoL benefits using a validated instrument. Secondary end-points included toxicity, (specifically bone marrow depression, pain 'flare' and/or other unexpected morbidity), and PSA 'response' following Sr-89. MATERIALS AND METHODSThis was a prospective multicentre study involving 13 oncology centres in 5 states and territories of Australia. Accrual took place over a two-year period from mid 1995 to mid 1997. There was a minimum 8-month interval from the date of Sr-89 injection in the last study patient to analysis, with a median follow up overall of 6.8 months (censoring patients at death).Eligible patients were those who had histologically proven prostate cancer with bone scan evidence of metastatic disease and who had progressed either clinically, biochemically or both following 'standard' first-line hormone therapy (with or without further hormonal manoeuvres), and who had one or more sites of bony pain. 7 patients had previously been treated with various chemot...

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It is recognized that the effects of palliative treatment extend beyond simply reducing the severity of a reference symptom, such as pain.

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confidence: 99%

Less pain does equal better quality of life following strontium-89 therapy for metastatic prostate cancer

et al. 2001

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“…As can be seen, the methodological characteristics varied across studies, as well as the alternatives compared, they are different in all the studies. The economic evaluation techniques used were costeffectiveness analysis 9,15,16 and cost-utility analysis. 10 -14 Outcome measures used were monetary units per years of life gained or per month of survival in the case of costeffectiveness analysis, 9,15,16 and monetary units per quality adjusted life years (QALY) in the case of cost-utility analysis 10 -14 (Tables 1 and 2).…”

Section: Resultsmentioning

confidence: 99%

Could we measure the efficiency of prostate cancer treatment? A critical appraisal of economic evaluation studies

García-Altés

Aj²

2001

Prostate Cancer Prostatic Dis

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The objective of this paper is to introduce the methodology of economic analysis in health care, and its application to the measurement of the efficiency analysis of prostate cancer treatment. We presented the methodology of economic analysis. To review its application in prostate cancer treatment, we performed a bibliographic search in the main biomedical databases (February 1988 -January 2001 to identify economic evaluation studies that compared both costs and effects of prostate cancer treatments. The lack of economic studies for localized prostate cancer and the diversity of treatments for advanced prostate cancer make it difficult to make comparisons across studies and to make therapeutic recommendations. Prostate Cancer and Prostatic Diseases (2001) 4, 217-220.

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“…Since then, several phase III studies (8)(9)(10)(11) have demonstrated the usefulness and cost-effectiveness of Sr-89 as either an alternative or adjunct to EBRT in males with bone pain resulting from metastatic prostate cancer. In Japan, a phase III clinical trial of Sr-89 was conducted in 1995; however, approval for this drug was not obtained, due to problems with the evaluation method (12).…”

Section: Discussionmentioning

confidence: 99%

Palliative effects and adverse events of strontium-89 for prostate cancer patients with bone metastasis

Furubayashi

Negishi

Ura

et al. 2014

Molecular and Clinical Oncology

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Abstract. The aim of the present study was to evaluate the palliative effects and adverse events of strontium-89 (Sr-89) in patients with bone metastasis from prostate cancer. A total of 18 patients with prostate cancer and painful bone metastases, as diagnosed on bone scintigraphy, who were treated with Sr-89 at the National Kyushu Cancer Center between February, 2008 and April, 2014 were reviewed. Of the 18 subjects, 13 (72.2%) achieved a pain response, whereas 5 were classified as pain non-responders (27.8%). According to a logistic regression analysis, the pre-administration characteristics, including age, prostate-specific antigen (PSA), alkaline phosphatase (ALP), history of bone-modifying agent administration, opioid use or palliative radiation therapy, time after the combined androgen blockade nadir and time since the pain onset, were not found to be significant predictors of the pain response. Similarly, the post-administration characteristics, including pain flares and the PSA and ALP response, were not found to be significant predictors of the pain response. Although no patients exhibited leukocyte toxicities, 2 patients experienced myelosuppression, involving anemia and thrombocytopenia, requiring transfusion of red cell or platelet concentrate following Sr-89 treatment. Of the 18 patients, 5 (27.8%) reported pain flares, all of whom were successfully treated with rescue drugs alone. According to the logistic regression analysis, of the pre-administration characteristics, only ALP was identified as a significant predictor of bone marrow suppression in the univariate and multivariate analyses (P=0.006). Therefore, Sr-89 treatment was found to be effective in ameliorating bone pain associated with metastasis from prostate cancer. Although it is difficult to identify the patients who will receive pain relief prior to Sr-89 administration, this drug should be administered during the early stages due to the potential for bone marrow suppression in patients with high ALP levels.

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A retrospective analysis of the cost effectiveness of treatment with Metastron?? (89Sr-chloride) in patients with prostate cancer metastatic to bone

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Less pain does equal better quality of life following strontium-89 therapy for metastatic prostate cancer

Less pain does equal better quality of life following strontium-89 therapy for metastatic prostate cancer

Could we measure the efficiency of prostate cancer treatment? A critical appraisal of economic evaluation studies

Palliative effects and adverse events of strontium-89 for prostate cancer patients with bone metastasis

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