Abstract

A cost–utility analysis was performed based on the Rethinking Clinical Trials (REaCT) bone-targeted agents (BTA) clinical trial that compared 12-weekly (once every 12 weeks) (n = 130) versus 4-weekly (once every 4 weeks) (n = 133) BTA dosing for metastatic breast and castration-resistant prostate (CRPC) cancer. Using a decision tree model, we calculated treatment and symptomatic skeletal event (SSE) costs as well as quality-adjusted life-years (QALYs) for each treatment option. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the study findings. The total cost of BTA treatment in Canadian dollars (C$) and estimated QALYs was C$8965.03 and 0.605 QALY in the 4-weekly group versus C$5669.95 and 0.612 QALY in the 12-weekly group, respectively. De-escalation from 4-weekly to 12-weekly BTA reduces cost (C$3293.75) and improves QALYs by 0.008 unit, suggesting that 12-weekly BTA dominates 4-weekly BTA in breast and CRPC patients with bone metastases. Sensitivity analysis suggests high levels of uncertainty in the cost-effectiveness findings. De-escalation of bone-targeted agents is cost-effective from the Canadian public payer’s perspective.

Highlights

  • The optimal dosing interval for bone-targeted agents (BTA) in patients with cancer with bone metastases remains an important clinical question

  • The study found that 12-weekly BTA treatment was non-inferior to 4-weekly BTA based on the primary outcome of change in patient reported health-related quality of life

  • Shapiro et al performed a costeffectiveness analysis using a Markov model. Their analysis was based on the Cancer and Leukemia Group B/Alliance for Clinical Trials in Oncology (CALGB/Alliance) 70604 study, which explored the de-escalation of zoledronate to every 3 months

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Summary

Introduction

The optimal dosing interval for bone-targeted agents (BTA) in patients with cancer with bone metastases remains an important clinical question. This study is the largest prospective randomized, open label, clinical trial to date, involving patients with bone metastases from either breast or CRPC and comparing 12-versus 4-weekly dosing of the three most commonly used BTAs [4]. Shapiro et al performed a costeffectiveness analysis using a Markov model Their analysis was based on the Cancer and Leukemia Group B/Alliance for Clinical Trials in Oncology (CALGB/Alliance) 70604 study, which explored the de-escalation of zoledronate to every 3 months. It remains to be seen whether their findings will be applicable to patients who may receive other BTAs. To inform the decision to implement BTA de-escalation in Canada, we sought to determine the cost-effectiveness of 12-versus 4-weekly BTA treatment from the perspective of Canada’s public healthcare system using the REaCT-BTA trial data

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