Cost-Effectiveness of Fracture Prevention in Men Who Receive Androgen Deprivation Therapy for Localized Prostate Cancer

Abstract

Background Androgen deprivation therapy (ADT) increases the risk for fractures in patients with prostate cancer. Objective To assess the cost-effectiveness of measuring bone mineral density (BMD) before initiating ADT followed by alendronate therapy in men with localized prostate cancer. Design Markov state-transition model simulating the progression of prostate cancer and the incidence of hip fracture. Data Sources Published literature. Target Population A hypothetical cohort of men aged 70 years with locally advanced or high-risk localized prostate cancer starting a 2-year course of ADT after radiation therapy. Time Horizon Lifetime. Perspective Societal. Intervention No BMD test or alendronate therapy, a BMD test followed by selective alendronate therapy for patients with osteoporosis, or universal alendronate therapy without a BMD test. Outcome Measures Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained. Results of Base-Case Analysis The ICERs for the strategy of a BMD test and selective alendronate therapy for patients with osteoporosis and universal alendronate therapy without a BMD test were $66 800 per QALY gained and $178 700 per QALY gained, respectively. Results of Sensitivity Analyses The ICER for universal alendronate therapy without a BMD test decreased to $100 000 per QALY gained, assuming older age, a history of fractures, lower mean BMD before ADT, or a lower cost of alendronate. Limitations No evidence shows that alendronate reduces actual fracture rates in patients with prostate cancer who receive ADT. The model predicted fracture rates by using data on the surrogate BMD end point. Conclusion In patients starting adjuvant ADT for locally advanced or high-risk localized prostate cancer, a BMD test followed by selective alendronate for those with osteoporosis is a cost-effective use of resources. Routine use of alendronate without a BMD test is justifiable in patients at higher risk for hip fractures. Primary Funding Source None.

Prevalence of osteoporosis among cancer patients in Germany

“…Because cancer patients will more frequently suffer from osteoporosis and its implications with rising probability of survival, many authors have already postulated the need for a BMD screening in these patients [4][5][6].…”

Clinical Efficacy and Cost-Effectiveness of Lanthanum Carbonate as Second-Line Therapy in Hemodialysis Patients in Japan

“…In this simulation, the ICERs based on the US drug prices in 2008, 2009, and 2010 were $47,240, $57,591, and $68,441 per QALY gained, respectively. Although healthcare decision makers in the US generally agree that interventions that cost less than $50,000 per QALY gained are reasonably efficient, it should be noted that the choice of an efficient cost-effectiveness threshold is dependent on several factors, and several cost-effectiveness analyses considered $50,000 to $100,000 per QALY gained to be cost-effective (53)(54)(55). Thus, the results of our additional analysis suggest that LC may also be cost-effective for uncontrolled hyperphosphatemia patients receiving hemodialysis in the US, unless the dose or cost of LC increases further.…”

Health Care Costs for Prostate Cancer Patients Receiving Androgen Deprivation Therapy: Treatment and Adverse Events

“…Other studies have examined the overall cost of care in patients receiving adt 30-34 or the cost of treating or preventing fragility fractures in this population 18,35 . Other strengths of our study include the use of a large population-based sample of all pca patients 66 years of age and older who received adt in a large Canadian province.…”