Effectiveness and cost of bisphosphonate therapy in tumor bone disease
Effectiveness and cost of bisphosphonate therapy in tumor bone disease
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DOI：
10.1002/cncr.11139
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发表时间：
2003-02-01
期刊：
影响因子：
6.2
通讯作者：
Body, JJ
中科院分区：
文献类型：
--
作者：
Body, JJ
背景资料。乳腺癌和骨髓瘤引起的肿瘤引起的骨溶解是严重影响患者生活质量的重要原因。据报道，破骨细胞介导的骨吸收在肿瘤性骨疾病患者中显著增加，并可被双膦酸盐治疗抑制。方法：对乳腺癌骨转移患者或骨髓瘤患者的骨骼并发症发生率和双膦酸盐治疗的有效性进行了大规模、长期的安慰剂对照试验。据作者所知，到目前为止，很少有研究发表评估双膦酸盐治疗的成本-效果，确实存在的大多数研究是基于模型，并且仅适用于特定的医疗保健系统。结果：从上述试验的安慰剂组中，可以估计大约25%-40%的乳腺癌转移到骨的患者将需要放射治疗来治疗骨痛，大约17%-50%的患者每年将持续发生脊椎骨折。据报道，骨髓瘤患者的并发症发生率较低。据报道，长期服用双膦酸盐可将骨骼相关事件的发生率降低约25%-50%。目前以每月静脉输液为基础的治疗方案似乎取得了最大的疗效。静脉给药比口服给药似乎更容易获得有益的效果。双膦酸盐治疗的成本似乎高于预防骨骼相关事件所节省的成本。经生活质量调整后的每一年的成本估计为10万英镑，但还需要更多研究。有限的数据表明，唑来膦酸不会降低治疗成本，但较短的输液时间将为患者和门诊肿瘤机构节省大量时间。结论：就像许多用于肿瘤的药物一样，双膦酸盐仍然是一种相对昂贵的治疗方法。需要更多的研究来正确评估它们的成本-效果比。目前的治疗方案已经达到了天花板效应，需要正确评估针对个别患者的量身定制治疗，以在不增加治疗成本的情况下进一步提高治疗效果和生活质量。(C)2003年美国癌症协会。
BACKGROUND. Tumor-induced osteolysis due to breast carcinoma and myeloma is responsible for a considerable morbidity that severely impairs patients' quality of life. Osteoclast-mediated bone resorption is reported to be increased markedly in patients with tumor bone disease and can be inhibited by bisphosphonate therapy.METHODS. The incidence of skeletal complications and the effectiveness of bisphosphonate therapy in patients with breast carcinoma metastatic to bone or in those with myeloma were derived from large-scale, long-term, placebo-controlled trials with clodronate or pamidronate. To the authors' knowledge, there are few studies published to date evaluating the cost-effectiveness of bisphosphonate therapy, and the majority that do exist often are based on models and are applicable only to a particular health care system.RESULTS. From the placebo groups of the above-mentioned trials, one can estimate that approximately 25-40% of the patients with breast carcinoma metastatic to bone will require radiotherapy for bone pain and approximately 17-50% will sustain incident vertebral fractures yearly. The incidence of complications is reported to be lower in myeloma patients. The prolonged administration of bisphosphonates reportedly can reduce the frequency of skeletal-related events by approximately 25-50%. Maximal efficacy appears to have been achieved with the current therapeutic schemes based on monthly intravenous infusions. Beneficial effects appear to be obtained more readily using the intravenous route rather than the oral route. The costs of bisphosphonate therapy appear to be higher than the cost savings from the prevention of skeletal-related events. The costs per quality of life-adjusted year have been estimated to be > $100,000, but more research is needed. Limited data suggest that zoledronic acid will not reduce treatment costs but the short infusion time will lead to substantial time savings for patients and for outpatient oncology facilities.CONCLUSIONS. As is the case for many agents used in oncology, bisphosphonates remain a relatively expensive therapy. More studies are needed to evaluate their cost-effectiveness ratio correctly. A ceiling effect has been reached with current therapeutic schemes and tailoring therapy to the individual patient needs to be evaluated correctly to increase therapeutic effectiveness and improve quality of life further without increasing treatment costs. (C) 2003 American Cancer Society.