Cost-utility of adjuvant zoledronic acid in patients with breast cancer and low estrogen levels

Lamond, Nathan W D, Skedgel, Christopher, Rayson, Daniel and Younis, Tallal (2015) Cost-utility of adjuvant zoledronic acid in patients with breast cancer and low estrogen levels. Current Oncology, 22 (4). e246-e253. ISSN 1198-0052

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Abstract

BACKGROUND: Adjuvant zoledronic acid (za) appears to improve disease-free survival (dfs) in women with early-stage breast cancer and low levels of estrogen (lle) because of induced or natural menopause. Characterizing the cost-utility (cu) of this therapy could help to determine its role in clinical practice. METHODS: Using the perspective of the Canadian health care system, we examined the cu of adjuvant endocrine therapy with or without za in women with early-stage endocrine-sensitive breast cancer and lle. A Markov model was used to compute the cumulative costs in Canadian dollars and the quality-adjusted life-years (qalys) gained from each adjuvant strategy, discounted at a rate of 5% annually. The model incorporated the dfs and fracture benefits of adjuvant za. Probabilistic and one-way sensitivity analyses were conducted to examine key model parameters. RESULTS: Compared with a no-za strategy, adjuvant za in the induced and natural menopause groups was associated with, respectively, $7,825 and $7,789 in incremental costs and 0.46 and 0.34 in qaly gains for cu ratios of $17,007 and $23,093 per qaly gained. In one-way sensitivity analyses, the results were most sensitive to changes in the za dfs benefit. Probabilistic sensitivity analysis suggested a 100% probability of adjuvant za being a cost-effective strategy at a threshold of $100,000 per qaly gained. CONCLUSIONS: Based on available data, adjuvant za appears to be a cost-effective strategy in women with endocrine-sensitive breast cancer and lle, having cu ratios well below accepted thresholds.

Item Type: Article
Uncontrolled Keywords: adjuvant therapy,zoledronic acid,breast cancer,bone health,cost–utility,economic analyses
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: Pure Connector
Date Deposited: 19 Nov 2015 08:15
Last Modified: 17 Mar 2020 21:08
URI: https://ueaeprints.uea.ac.uk/id/eprint/55409
DOI: 10.3747/co.22.2383

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