Test and treat bone loss strategy cost-effective for prostate cancer patients
MedWire News: Bone loss in hormone-treated prostate cancer patients can be managed cost effectively using bone mineral density (BMD) and antiresorptive therapy, US study results show.
Kouta Ito, from the Memorial Sloan-Kettering Cancer Center in New York, and colleagues found that “routine use of [antiresorptive therapy] is not justifiable unless patients are older, have a history of fractures, or have lower mean BMD before androgen deprivation therapy (ADT).”
The team compared the cost-effectiveness of only giving antiresorptive therapy to men with osteoporosis identified by BMD, with universal antiresorptive therapy without initial BMD testing.
The cohort was a simulated group of men aged 70 years, who were treated with ADT for 2 years following radiotherapy for locally advanced or high-risk localized prostate cancer.
Factors accounted for in the hypothetical cohort included gradual bone loss from ADT treatment, the incidence of previous fractures, the natural adjustment of BMD with age, and the natural progression of prostate cancer (including metastases and death).
The researchers used average Medicare costs for BMD testing and antiresorptive therapy, and health benefits in the cohort were measured using quality-adjusted life-years (QALYs) gained.
Compared with a no BMD test–no antiresorptive therapy approach, the BMD test and antiresorptive therapy for men with osteoporosis for 5 years had an incremental cost-effectiveness ratio (ICER) of US $66,800 (€54,093) per QALY gained.
Universal antiresorptive therapy without a BMD test was more expensive, at US $178,700 (€144,708) per QALY gained.
The results show no difference in QALYs gained between the BMD test and selective antiresorptive therapy approach and the universal antiresorptive therapy approach, at 6.6 QALYs for each.
In addition to being the most expensive, the universal antiresorptive therapy was also the most effective. The method resulted in a 9.9% cumulative lifetime probability of hip fracture, compared with a 12.0% probability for the BMD test and selective antiresorptive therapy approach.
However, in order to be economically justifiable, the universal antiresorptive therapy approach would need to be offered only to patients at high risk for hip fracture, such as older men, those with a lower BMD before ADT, and those with a history of fractures, conclude Ito et al in the Annals of Internal Medicine.
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