Cost-Effectiveness Analysis of 12-Versus 4-Weekly Administration of Bone-Targeted Agents in Patients with Bone Metastases from Breast and Castration-Resistant Prostate Cancer
Abstract
:1. Introduction
2. Materials and Methods
2.1. Costs
2.2. Outcomes
2.3. Assumptions
2.4. Analysis
3. Results
Sensitivity Analysis
4. Discussion
4.1. Strengths and Limitations
4.2. Interpretation Considering Other Studies
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Appendix A
4-Weekly | 12-Weekly | |||||
---|---|---|---|---|---|---|
Cost of Drug (C$) [8] | Cost of Administration (C$) [6] | Total Cost (C$) | Cost of Drug (C$) [8] | Cost of Administration (C$) [6] | Total Cost (C$) | |
Denosumab (Xgeva) | 7387.34 | 372.00 | 7759.34 | 2462.45 | 124.00 | 2586.45 |
Pamidronate | 130.68 | 227.64 | 358.32 | 43.56 | 975.88 | 1019.44 |
Zoledronate | 96.72 | 2370.00 | 266.72 | 32.24 | 790.00 | 822.24 |
Appendix B
Variable | Value (C$) | Source |
---|---|---|
Radiotherapy to relieve bone pain | ||
Average cost of external beam radiotherapy to axial skeleton (1AW27JA,1EA27JA,1SQ27JA) | 18,223 | [7] |
Radiation oncologist—consultation (A345) | 152.40 | [9] |
Radiation oncologist—radiation treatment planning—level 3 (X312) | 680.45 | [9] |
Total cost of radiotherapy to relieve bone pain | 19,055.85 | |
Pathological fracture | ||
Average cost of pathological fracture, pelvic region and thigh (M8445) | 4890 | [7] |
Orthopedic surgeon—consultation (A065) | 83.10 | [9] |
Orthopedic surgeon—fractures—open reduction (F096)—“femoral nail fixation” = $493.80 | 492.38 | [9] |
Orthopedic surgeon—fractures—open reduction—primary prosthesis, femur only (F101) “partial hip replacement for neck fracture” = $490.95 | [9] | |
Radiation oncologist—radiation treatment planning—level 3 (X312) | 680.45 | [9] |
Anesthesiologist (see Appendix C for cost breakdown) | 405.27 | [9] |
Total cost to treat pathological fracture | 6145.93 | |
Spinal cord compression | ||
Average cost of cord compression (G952) | 6496 | [7] |
Radiation oncologist—consultation (A345) | 152.40 | [9] |
Radiation oncologist—radiation treatment planning—level 3 (X312) | 680.45 | [9] |
Total cost to treat spinal cord compression | 7328.85 | |
Tumor-related orthopedic surgical intervention | ||
Average cost of prophylactic surgery (Z408, Z409)—day surgery | 2375 | [7] |
Orthopedic surgeon—consultation (A065) | 83.1 | [9] |
Orthopedic tumor surgery—biopsy of suspected sarcoma, or resection of a complex bone or complex soft tissue | 600 | [9] |
tumor(s), $100 per 15 min (R226A), assume 90min—“general oncology” | ||
Orthopedic surgeon—bone—major tumor resection (R330)—“tumor excision” | 629.65 | [9] |
Average cost of the two surgeries | 614.83 | [9] |
Anesthesiologist (see Appendix C for cost breakdown) | 405.27 | |
Total cost for tumour-related orthopedic surgical intervention | 3478.195 | |
Hypercalcemia | ||
Average cost of disorder of calcium metabolism (E835) | 7448 | [7] |
Medical oncologist—consultation (A445) | 157 | [9] |
Total cost to treat hypercalcemia | 7605 |
Appendix C
Description | Base price [9] | Units | Total | Average |
---|---|---|---|---|
Pathological fracture | C$405.27 | |||
F096 (75–90 min (use 90 min) + 30 min pre/post-op) | C$15.01 | |||
To start case | 8 | C$120.08 | ||
First 60 min (1 unit per 15 min) | 4 | C$60.04 | ||
60–90 min (2 units per 15 min) | 4 | C$60.04 | ||
>90 min (4 units per 15 min) | 8 | C$120.08 | ||
ASAII (E022C × 2 units) | 2 | C$30.02 | ||
C$390.26 | ||||
F101 (75–90 min (use 90 min) + 30 min pre/post op) | C$15.01 | |||
To start case | 10 | C$150.10 | ||
First 60 min (1 unit per 15 min) | 4 | C$60.04 | ||
60–90 min (2 units per 15 min) | 4 | C$60.04 | ||
>90 min (4 units per 15 min) | 8 | C$120.08 | ||
ASAII (E022C × 2 units) | 2 | C$30.02 | ||
C$420.28 | ||||
Tumor-related orthopedic surgical intervention | C$405.27 | |||
R226A (45 min–24 h (use 90 min) + 30 min pre/post op) | C$15.01 | |||
To start case | 15 | C$225.15 | ||
First 60 min (1 unit per 15 min) | 4 | C$60.04 | ||
60–90 min (2 units per 15 min) | 4 | C$60.04 | ||
> 90 min (4 units per 15 min) | 8 | C$120.08 | ||
C$465.31 | ||||
R330 | C$15.01 | |||
To start case | 7 | C$105.07 | ||
First 60 min (1 unit per 15 min) | 4 | C$60.04 | ||
60–90 min (2 units per 15 min) | 4 | C$60.04 | ||
>90 min (4 units per 15 min) | 8 | C$120.08 | ||
$345.23 |
Appendix D
SSE | Number of Events [Proportion of Total Events] | Weighted Cost (C$) of Each SSE | ||
---|---|---|---|---|
4-Weekly | 12-Weekly | 4-Weekly | 12-Weekly | |
Radiotherapy to bone | 35 [0.78] | 38 [0.86] | 14,821.22 | 16,457.33 |
Hypercalcemia | 4 [0.089] | 1 [0.023] | 676.00 | 172.84 |
Pathological fracture | 4 (0.089) | 2 [0.045] | 546.30 | 279.36 |
Spinal cord compression | 2 [0.044] | 1 [0.023] | 325.73 | 166.56 |
Surgery to bone | 0 [0] | 2 [0.045] | 0.00 | 158.10 |
Total | 45 | 44 | 16,369.25 | 17,234.19 |
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Baseline | Lower limit | Upper limit | Reference | |
---|---|---|---|---|
Probabilities | ||||
Probability of SSE with 4-weekly BTA | 0.203 | 0.1338 | 0.2954 | [4] |
Probability of no SSE with 4-weekly BTA | 0.797 | 0.6525 | 0.9639 | [4] |
Probability of SSE with 12-weekly BTA | 0.223 | [4] | ||
Probability of no SSE with 12-weekly BTA | 0.777 | [4] | ||
De-escalation effect (relative risk) | ||||
Reduction of BTA treatment from 4-weekly to 12-weekly | 1.099 | 0.6902 | 1.7496 | [4] |
Costs per year | ||||
Weighted cost of 4-weekly BTA | C$5642.07 | C$4513.66 | C$6770.48 | Appendix A |
Weighted cost of 12-weekly BTA | C$1826.73 | C$1461.38 | C$2192.08 | Appendix A |
Weighted cost of SSE in 4-weekly BTA group | C$16,369.25 | C$13,095.40 | C$19,643.10 | Appendix B |
Weighted cost of SSE in 12-weekly BTA group | C$17,234.19 | C$13,787.35 | C$20,681.03 | Appendix B |
Costs | QALY | |
---|---|---|
4-weekly BTA | C$8965.03 | 0.605 |
12-weekly BTA | C$5671.28 | 0.612 |
Incremental | −C$3293.75 | 0.008 |
ICER (∆ cost/∆ QALY) | 12-weekly dominates 4-weekly | |
Incremental net benefit (INB) * | C$3681.37 | |
* The INB is based upon an assumption that the willingness to pay for one QALY is C$50,000 | ||
If INB > 0 = intervention is cost effective | ||
If INB < 0 = not cost effective |
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Tu, M.M.; Clemons, M.; Stober, C.; Jeong, A.; Vandermeer, L.; Mates, M.; Blanchette, P.; Joy, A.A.; Aseyev, O.; Pond, G.; et al. Cost-Effectiveness Analysis of 12-Versus 4-Weekly Administration of Bone-Targeted Agents in Patients with Bone Metastases from Breast and Castration-Resistant Prostate Cancer. Curr. Oncol. 2021, 28, 1847-1856. https://doi.org/10.3390/curroncol28030171
Tu MM, Clemons M, Stober C, Jeong A, Vandermeer L, Mates M, Blanchette P, Joy AA, Aseyev O, Pond G, et al. Cost-Effectiveness Analysis of 12-Versus 4-Weekly Administration of Bone-Targeted Agents in Patients with Bone Metastases from Breast and Castration-Resistant Prostate Cancer. Current Oncology. 2021; 28(3):1847-1856. https://doi.org/10.3390/curroncol28030171
Chicago/Turabian StyleTu, Megan M., Mark Clemons, Carol Stober, Ahwon Jeong, Lisa Vandermeer, Mihaela Mates, Phillip Blanchette, Anil Abraham Joy, Olexiy Aseyev, Gregory Pond, and et al. 2021. "Cost-Effectiveness Analysis of 12-Versus 4-Weekly Administration of Bone-Targeted Agents in Patients with Bone Metastases from Breast and Castration-Resistant Prostate Cancer" Current Oncology 28, no. 3: 1847-1856. https://doi.org/10.3390/curroncol28030171
APA StyleTu, M. M., Clemons, M., Stober, C., Jeong, A., Vandermeer, L., Mates, M., Blanchette, P., Joy, A. A., Aseyev, O., Pond, G., Fergusson, D., Ng, T. L., & Thavorn, K. (2021). Cost-Effectiveness Analysis of 12-Versus 4-Weekly Administration of Bone-Targeted Agents in Patients with Bone Metastases from Breast and Castration-Resistant Prostate Cancer. Current Oncology, 28(3), 1847-1856. https://doi.org/10.3390/curroncol28030171