Cost-effectiveness of fracture prevention in men who receive androgen deprivation therapy for localized prostate cancer.
Cost-effectiveness of fracture prevention in men who receive androgen deprivation therapy for localized prostate cancer.
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DOI：
10.7326/0003-4819-152-10-201005180-00002
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发表时间：
2010-05-18
影响因子：
39.2
通讯作者：
Morris MJ
中科院分区：
文献类型：
--
作者：
Ito K;Elkin EB;Girotra M;Morris MJ
雄激素剥夺治疗（ADT）增加前列腺癌患者骨折的风险。评估局限性前列腺癌患者在开始ADT治疗后接受阿仑膦酸钠治疗前测量骨密度（BMD）的成本效益。马尔可夫状态转移模型模拟前列腺癌的进展和髋部骨折的发病率。出版的文献。一个假设队列，年龄70岁的局部晚期或高风险局限性前列腺癌男性在放疗后开始接受为期2年的ADT治疗。辈子社交无BMD测试或阿仑膦酸钠治疗，骨质疏松症患者进行BMD测试后选择性阿仑膦酸钠治疗，或无BMD测试的通用阿仑膦酸钠治疗。增量成本效益比（ICER），通过获得的每质量调整生命年（QALY）成本来衡量。针对骨质疏松症患者进行骨密度测试和选择性阿仑膦酸钠治疗以及不进行骨密度测试的普遍阿仑膦酸钠治疗策略的ICER分别为每增加一个QALY 66 800美元和每增加一个QALY 178 700美元。假设年龄较大、有骨折史、ADT前平均BMD较低或阿仑膦酸钠的成本较低，则无BMD测试的阿仑膦酸钠治疗的ICER降至每QALY增加10万美元。没有证据表明阿仑膦酸钠可以降低接受ADT治疗的前列腺癌患者的实际骨折率。该模型通过使用替代BMD终点的数据预测骨折率。在开始辅助ADT治疗局部晚期或高危局限性前列腺癌的患者中，骨密度检测后选择性阿仑膦酸钠治疗骨质疏松症是一种具有成本效益的资源利用方式。在髋部骨折风险较高的患者中，常规使用阿仑膦酸钠而不进行BMD测试是合理的。没有。
Androgen deprivation therapy (ADT) increases the risk for fractures in patients with prostate cancer. To assess the cost-effectiveness of measuring bone mineral density (BMD) before initiating ADT followed by alendronate therapy in men with localized prostate cancer. Markov state-transition model simulating the progression of prostate cancer and the incidence of hip fracture. Published literature. 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. Lifetime. Societal. 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. Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained. 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. 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. 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. 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. None.