Cost-effectiveness of alendronate therapy for men with prostate cancer

January 01, 0001

Cost-effectiveness of alendronate therapy for men with prostate cancer

Androgen deprivation therapy (ADT) increases the risk for fractures in patients with prostate cancer. These US authors assessed the cost- effectiveness of measuring bone mineral density (BMD) before initiating ADT followed by alendronate therapy in men with localized prostate cancer. They designed a Markov state-transition model simulating the progression of prostate cancer and the incidence of hip fracture using data from the published literature for a target population of men aged 70 years with locally advanced or high-risk localized prostate cancer starting a 2-year course of ADT after radiation therapy. The principal outcome measure was incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life- year (QALY) gained.

They found: "Results of Base-Case Analysis: 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. Results of Sensitivity Analyses: 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."

The authors concluded: "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."

These results should be tested in clinical trials.

For the full abstract, click here.

Annals of Internal Medicine 152(10):621-629, 18 May 2010
© 2010 to the American College of Physicians
Cost-Effectiveness of Fracture Prevention in Men Who Receive Androgen Deprivation Therapy for Localized Prostate Cancer. Kouta Ito, Elena B. Elkin, Monica Girotra, Michael J. Morris. Correspondence to Dr. Ito: [email protected]

Category: Y. Male Genital System, Breast. Keywords: prostate cancer, fractures, bone mineral density, osteoporosis, alendronate, quality-adjusted life year, QALY, cost-effectiveness analysis, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 8 June 2010

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