Cost-effectiveness of zoledronic acid for the prevention of skeletal complications in patients with prostate cancer
Cost-effectiveness of zoledronic acid for the prevention of skeletal complications in patients with prostate cancer
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DOI：
10.1097/01.ju.0000116777.94426.60
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发表时间：
2004-04-01
影响因子：
6.6
通讯作者：
Schulman, KA
中科院分区：
文献类型：
--
作者：
Reed, SD;Radeva, JI;Schulman, KA
目的：我们估计的成本效益唑来膦酸与安慰剂减少骨骼并发症的男性prostate cancer.Materials和方法：我们进行了成本效益分析，同时唑来膦酸的多国临床试验。成本估计基于前瞻性收集的85.3%入组患者的资源使用数据。成本效益比的基础上，在临床结果，生活质量和研究药物cost.Results的试验数据：接受唑来膦酸的患者经历了更少的住院天数在平均随访9个月（平均5.6比8.0天，p=0.1910）。不包括研究药物的平均直接费用，唑来膦酸组为5，365美元，安慰剂组为5，689美元，差异为324美元（95%CI 1，781 - 1，146美元）。唑来膦酸加上试验期间的给药全球平均成本为5，677美元（每剂450美元）。避免的每例骨骼并发症的名义成本为12，300美元（95% CI 6，900至48，700美元），无骨骼并发症的每例额外患者的成本为51，400美元（95% CI 26，900至243，700美元）。每质量调整生命年的名义试验内成本为159，200美元，在敏感性分析中差异很大。结论：唑来膦酸预防前列腺癌骨骼并发症的每质量调整生命年成本的名义基础病例估计与双磷酸盐治疗乳腺癌的结果一致。然而，双膦酸盐的成本效益比高于通常引用的成本效益阈值。
Purpose: We estimated the cost-effectiveness of zoledronic acid vs placebo for decreasing skeletal complications in men with prostate cancer.Materials and Methods: We performed a cost-effectiveness analysis alongside a multinational clinical trial of zoledronic acid. Cost estimation was based on prospectively collected resource use data for 85.3% of enrolled patients. Cost-effectiveness ratios were based on within-trial data on clinical outcomes, quality of life and study medication cost.Results: Patients receiving zoledronic acid experienced fewer hospital days during a mean followup of 9 months (average 5.6 vs 8.0 days; p=0.1910). Mean direct costs excluding study medication were $5,365 for patients receiving zoledronic acid and $5,689 for patients receiving placebo, a difference of $324 (95% CI $1,781 to $1,146). The global average cost of zoledronic acid plus its administration during the trial was $5,677 ($450 per dose). The nominal cost per skeletal complication avoided was $12,300 (95% CI $6,900 to $48,700) and the cost per additional patient free of skeletal complications was $51,400 (95% CI $26,900 to $243,700). Nominal within-trial cost per quality adjusted life-year was $159,200, which varied widely in sensitivity analyses.Conclusions: The nominal base case estimate of the cost per quality adjusted life-year for zoledronic acid in the prevention of skeletal complications of prostate cancer is consistent with that of bisphosphonates in breast cancer. However, the cost-effectiveness ratios for bisphosphonates are higher than commonly cited thresholds for conferring cost-effectiveness.