Cost-effectiveness of fracture prevention in men who receive androgen deprivation therapy for localized prostate cancer Journal Article
| Authors: | Ito, K.; Elkin, E. B.; Girotra, M.; Morris, M. J. |
| Article Title: | Cost-effectiveness of fracture prevention in men who receive androgen deprivation therapy for localized prostate cancer |
| Abstract: | Background: Androgen deprivation therapy (ADT) increases the risk for fractures in patients with prostate cancer. Objective: To assess the cost-effectiveness of measuring bone mineral density (BMD) before initiating ADT followed by alendronate therapy in men with localized prostate cancer. Design: Markov state-transition model simulating the progression of prostate cancer and the incidence of hip fracture. Data Sources: Published literature. Target Population: A hypothetical cohort of men aged 70 years with locally advanced or high-risk localized prostate cancer starting a 2-year course of ADT after radiation therapy. Time Horizon: Lifetime. Perspective: Societal. Intervention: No BMD test or alendronate therapy, a BMD test followed by selective alendronate therapy for patients with osteoporosis, or universal alendronate therapy without a BMD test. Outcome Measures: Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained. 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. Limitations: No evidence shows that alendronate reduces actual fracture rates in patients with prostate cancer who receive ADT. The model predicted fracture rates by using data on the surrogate BMD end point. Conclusion: 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. © 2010 American College of Physicians. |
| Keywords: | aged; aged, 80 and over; middle aged; disease course; cancer growth; cancer risk; drug potentiation; multimodality cancer therapy; antineoplastic agents; pathophysiology; cancer radiotherapy; combined modality therapy; antineoplastic agent; sensitivity analysis; quality of life; markov chains; risk factors; risk factor; gonadorelin; bone density; prostate cancer; prostatic neoplasms; cost effectiveness analysis; drug cost; probability; disease progression; prostate tumor; androgen antagonists; computer simulation; osteoporosis; antiandrogen; orchiectomy; androgen deprivation therapy; gonadotropin-releasing hormone; quality adjusted life year; cost-benefit analysis; bone density conservation agent; bone density conservation agents; alendronic acid; alendronate; cost benefit analysis; quality-adjusted life years; hip fracture; hidden markov model; hip fractures |
| Journal Title: | Annals of Internal Medicine |
| Volume: | 152 |
| Issue: | 10 |
| ISSN: | 0003-4819 |
| Publisher: | American College of Physicians |
| Date Published: | 2010-05-18 |
| Start Page: | 621 |
| End Page: | 629 |
| Language: | English |
| PUBMED: | 20479027 |
| PROVIDER: | scopus |
| PMCID: | PMC5468170 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: AIMEA" - "Source: Scopus" |
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