Objective
To evaluate the cost-effectiveness of adding zoledronic acid orstrontium-89 to standard docetaxel chemotherapy for patientswith castrate-refractory prostate cancer (CRPC).
Patients and methods
Data on resource use and quality of life for 707 patientscollected prospectively in the TRAPEZE 2 9 2 factorialrandomised trial (ISRCTN 12808747) were used to assess thecost-effectiveness of i) zoledronic acid versus no zoledronicacid (ZA vs. no ZA), and ii) strontium-89 versus nostrontium-89 (Sr89 vs. no Sr89). Costs were estimated fromthe perspec tive of the National Health Service in the UK andincluded expenditures for trial treatments, concomitantmedications, and use of related hospital and primary careservices. Q uality-adjusted life-years (QALYs) were calculatedaccording to patients’ responses to the generic EuroQol EQ-5D-3L instrument, which evaluates health status. Results areexpress ed as incremental cost-effectiveness ratios (ICERs) andcost-effectiveness acceptability curves.
Results
The per-patient cost for ZA was £12 66 7, £251 higher than theequivalent cost in the no ZA group. Patients in the ZA grouphad on average 0.03 QALYs more than their counterparts in noZA group. The ICER for this comparison was £8 005. Sr89 wasassociated with a cost of £13 230 , £1365 higher than no Sr89,and a gain of 0.08 QALYs compared to no Sr89. The ICER forSr89 was £16 884. The probabilities of ZA and Sr89 being cost-effective were 0.64 and 0.60, respectively.
Conclusions
The addition of bone-targeting treatments to standardchemotherapy led to a small improvement in QALYs for amodest increase in cost (or cost-savings). ZA and Sr89resulted in ICERs below conventional willingness-to-pa y perQALY thresholds, suggesting that their addition tochemotherapy may represent a cost-effective use of resources.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)