Longitudinal patterns of bone-targeted agent use among patients with solid tumors and bone metastases in the United States

Abstract

PurposeThis study examined real-world long-term use of guideline-recommended bone targeted agents (BTA) among patients with metastatic solid tumors.MethodsAdults with a solid tumor diagnosis followed by a bone metastasis diagnosis in 2012–2014 were identified from electronic medical records in the Oncology Services Comprehensive Electronic Records (OSCER) database. Patients initiated zoledronic acid (ZA) or denosumab on or after the bone metastasis diagnosis and were followed through last clinic visit by 30 June 2015. We describe time to BTA initiation, compliance (≥12 administrations in a year), switching, and non-persistence (switch or ≥90 day gap in therapy), by agent and follow-up period.ResultsThe majority of the 14,881 study patients (50% female, 65% age ≥65 years) had breast (33%), prostate (26%), or lung (26%) tumors. Half of all patients initiated on each agent, with denosumab initiations exceeding ZA initiations in 2014. Most (91% denosumab, 93% ZA) initiations occurred within 3 months of bone metastasis diagnosis. At 1, 2, and 3 years post-initiation, denosumab patients were less likely to switch agents (4, 3, and 1% versus 14, 12, and 11%) and more likely to be compliant (50, 37, and 31% versus 41, 26, and 6%). Median time to non-persistence was 25.9 months for denosumab and 17.2 months for ZA, p < 0.0001.ConclusionsThis is the first study reporting long-term treatment patterns for the two primary BTAs used in the USA. The greater compliance and longer persistence observed among denosumab patients may improve treatment effectiveness achieved in the real-world setting.Electronic supplementary materialThe online version of this article (doi:10.1007/s00520-017-3583-1) contains supplementary material, which is available to authorized users.

Real-world use of denosumab and bisphosphonates in patients with solid tumours and bone metastases in Germany

“…Additionally, determinants of differential usage patterns between agents can only be inferred. Furthermore, usage definitions must be meaningful; the 90-day gap definition for persistence and the 12 prescription definition for compliance were considered appropriate for this study and are in line with previously published studies [33,34]. Sensitivity analyses using alternative gaps (45, 60 and 120 days, and 10, 11 and 13 prescriptions per year) broadly confirmed the result of the primary analysis.…”

“…These results were confirmed in a 3-year study in which patients receiving denosumab were less likely to switch agents and more likely to demonstrate compliance with treatment at 1, 2 and 3 years across all solid tumour subtypes. Median time to non-persistence was also significantly longer for denosumab than for zoledronic acid [34].…”

“…In general, time to discontinuation was longer, compliance greater and switch rates lower in patients receiving denosumab than in those receiving bisphosphonates. The higher levels of persistence and compliance with denosumab than with bisphosphonates may be associated with improved outcomes in routine clinical practice [34]. Median time to discontinuation with denosumab was not reached and compliance data not reported in the lung cancer group owing to a small patient sample.…”

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

“…Patients with solid tumors and bone metastases at risk of a bone complication were included in the model. Data from the Oncology Services Comprehensive Electronic Records database of patients with solid tumors followed by a bone metastasis diagnosis were used for patient distribution by cancer type; for the model, patients were adults with breast (33%), prostate (26%), or other solid tumors (41% [26% lung; 15% other]) 41 .…”

“…Cost-effectiveness and NMB analyses were conducted from societal and direct-cost (payer) perspectives. For the societal analysis, 35% of patients were assumed to be eligible for short-term disability and productivity loss based on the proportion of patients assumed to be aged <65 years and, therefore, eligible to be employed full-time while being treated 41 .…”