OBJECTIVE
To analyze the clinical and economic feasibility of denosumab and zoledronic acid in prevention of bone-related complications in adults with solid tumors and bone metastases in Russian healthcare.
MATERIAL AND METHODS
We considered adults with newly diagnosed solid tumors such as breast cancer (BC), prostate cancer (PC) and other solid tumors, as well as bone metastases. The criterion of clinical efficiency was incidence of bone-related complications. In cost-effectiveness analysis, the number of quality adjusted life years (QALYs) was the effectiveness criterion. In addition, the number of prevented bone complications was assessed. We considered the costs of drug therapy for prevention of bone-related complications, outpatient follow-up and administration of drugs. The follow-up period was 5 years.
RESULTS
Denosumab therapy was associated with higher quality of life compared to zoledronic acid therapy. Throughout 5 years, denosumab added 0.17 QALYs for PC, 0.12 QALYs for BC and 0.14 QALYs for other solid tumors compared to zoledronic acid. The expected number of bone-related complications in a cohort of one thousand patients after denosumab therapy was lower by 381 (9.2%) events compared to zoledronic acid therapy (3.742 and 4.123, respectively). The costs of denosumab therapy were higher by 69.815.92 rubles (5.4%) for PC, 198.001.32 rubles (11.7%) for BC and 98.517.89 rubles (9.4%) for other solid tumors compared to zoledronic acid per patient over 5 years. The costs for one year of high quality life after denosumab therapy amounted to 1.72 million rubles within 1 year that was 73.5 thousand rubles (4.3%) lower compared to zoledronic acid. In case of 5-year period, the costs for one QALY after denosumab therapy amounted to 1.95 million rubles. This value was 215.8 thousand rubles (11.1%) lower compared to the cost of zoledronic acid therapy.
CONCLUSION
Denosumab is more economically feasible for prevention of bone-related complications in patients with solid tumors and bone metastases compared to zoledronic acid. Denosumab can be recommended for widespread use in Russian healthcare.
