PMID- 23300363
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20130115
LR  - 20231104
IS  - 1198-0052 (Print)
IS  - 1718-7729 (Electronic)
IS  - 1198-0052 (Linking)
VI  - 19
IP  - 6
DP  - 2012 Dec
TI  - Cost-effectiveness of zoledronic acid compared with clodronate in multiple 
      myeloma.
PG  - e392-403
LID - 10.3747/co.19.1004 [doi]
AB  - BACKGROUND: In the U.K. Medical Research Council Myeloma IX trial (mmix), 
      zoledronic acid 4 mg once every 3-4 weeks, compared with clodronate 1600 mg 
      daily, reduced the incidence of skeletal related events (sres), increased 
      progression-free survival (pfs), and prolonged overall survival (os) in 1970 
      patients with newly-diagnosed multiple myeloma. The incidence of confirmed 
      osteonecrosis of the jaw was higher with zoledronic acid than with clodronate. 
      The objective of the present study was to evaluate, based on the findings in 
      mmix, the cost-effectiveness of zoledronic acid compared with clodronate in 
      patients with newly-diagnosed multiple myeloma. METHODS: An economic model was 
      used to project pfs, os, the incidence of sres and adverse events, and expected 
      lifetime health care costs for patients with newly diagnosed multiple myeloma who 
      are alternatively assumed to receive zoledronic acid or clodronate. The 
      incremental cost-effectiveness ratio (icer) of zoledronic acid compared with 
      clodronate was calculated as the ratio of the difference in cost to the 
      difference in quality-adjusted life years (qalys). Model inputs were based on 
      results of mmix and published sources. Results were generated under different 
      assumptions regarding the beneficial effects of zoledronic acid on os beyond 5 
      years after treatment initiation. RESULTS: Assuming lifetime treatment effects of 
      zoledronic acid, treatment with zoledronic acid (compared with clodronate) 
      increased qalys by 0.27 at an additional cost of CA$13,407, yielding an icer of 
      CA$49,829 per qaly gained. If the threshold icer is CA$100,000 per qaly, the 
      estimated probability that zoledronic acid is cost-effective is 80%. Assuming 
      that the benefits of zoledronic acid on pfs and os diminish over 5 years 
      beginning at the end of year 5, the icer is CAN$63,027 per qaly gained. If the 
      benefits of zoledronic acid on pfs and os are assumed to persist for 5 years 
      only, the icer is CAN$76,948 per qaly gained. CONCLUSIONS: Compared with 
      clodronate, zoledronic acid represents a cost-effective treatment alternative in 
      patients with multiple myeloma.
FAU - Delea, T E
AU  - Delea TE
AD  - pai (Policy Analysis Inc.), Brookline, MA, U.S.A.
FAU - El Ouagari, K
AU  - El Ouagari K
FAU - Rotter, J
AU  - Rotter J
FAU - Wang, A
AU  - Wang A
FAU - Kaura, S
AU  - Kaura S
FAU - Morgan, G J
AU  - Morgan GJ
LA  - eng
PT  - Journal Article
PL  - Switzerland
TA  - Curr Oncol
JT  - Current oncology (Toronto, Ont.)
JID - 9502503
PMC - PMC3503670
OTO - NOTNLM
OT  - Multiple myeloma
OT  - bisphosphonates
OT  - clodronate
OT  - cost-effectiveness
OT  - zoledronic acid
EDAT- 2013/01/10 06:00
MHDA- 2013/01/10 06:01
PMCR- 2012/12/01
CRDT- 2013/01/10 06:00
PHST- 2013/01/10 06:00 [entrez]
PHST- 2013/01/10 06:00 [pubmed]
PHST- 2013/01/10 06:01 [medline]
PHST- 2012/12/01 00:00 [pmc-release]
AID - conc-19-e392 [pii]
AID - 10.3747/co.19.1004 [doi]
PST - ppublish
SO  - Curr Oncol. 2012 Dec;19(6):e392-403. doi: 10.3747/co.19.1004.