Economic evaluation of zoledronic acid for the prevention of osteoporotic fractures in postmenopausal women with early-stage breast cancer receiving aromatase inhibitors in the UK

• Published in: Annals of oncology Vol. 21; no. 7; pp. 1529 - 1536
• Main Authors: Logman, J.F.S., Heeg, B.M.S., Botteman, M.F., Kaura, S., van Hout, B.A.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.07.2010; Oxford University Press
• Subjects: Aged; Aged, 80 and over; AIBL; Antineoplastic agents; aromatase inhibitor; Aromatase Inhibitors - adverse effects; Biological and medical sciences; Bone Density - drug effects; Bone Density Conservation Agents - therapeutic use; bone loss; breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - economics; Breast Neoplasms - pathology; Cohort Studies; Cost-Benefit Analysis; cost-effectiveness; Diphosphonates - therapeutic use; Diseases of the osteoarticular system; Female; Gynecology. Andrology. Obstetrics; Humans; Imidazoles - therapeutic use; Letrozole; Mammary gland diseases; Markov Chains; Medical sciences; Middle Aged; Neoplasm Staging; Nitriles - adverse effects; Osteoporosis, Postmenopausal - economics; Osteoporosis, Postmenopausal - prevention & control; Osteoporosis. Osteomalacia. Paget disease; Pharmacology. Drug treatments; Quality-Adjusted Life Years; Salvage Therapy; Survival Rate; Treatment Outcome; Triazoles - adverse effects; Tumors; Zoledronic Acid; United Kingdom; Europe; cost-effectiveness; breast cancer; AIBL; zoledronic acid; bone loss; aromatase inhibitor; Antineoplastic agent; Antiosteoporotic; Breast disease; Menopause; Diseases of the osteoarticular system; Antiresorptive agent; Diphosphonic acid derivatives; Early stage; Fracture; Bisphosphonates; Prevention; Osteoporosis; Zoledronic acid; Postmenopause; Adult; Female; Bone defect; Woman; Osteopenia; Public health; Cost efficiency analysis; Human; Aromatase inhibitor; Breast cancer; Malignant tumor; Trauma; Mammary gland diseases; Health economy; Cancer
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mdp560

Aromatase inhibitors are used as adjuvant therapy for breast cancer (BC) and are associated with accelerated bone loss. Zoledronic acid (ZOL) prevents aromatase inhibitor-associated bone loss (AIBL) in postmenopausal women with BC. This analysis assessed the cost-effectiveness of ZOL for prevention of fractures in postmenopausal women with BC. A Markov model was developed to project lifetime incidence of fractures, quality-adjusted life years (QALY), and costs as a function of bone mineral density (BMD) for women with early-stage BC receiving letrozole alone or with ZOL. Two strategies of ZOL therapy were compared with no treatment: starting ZOL treatment only when BMD levels decreased (‘delayed ZOL’) and starting ZOL simultaneously with letrozole therapy (‘upfront ZOL’). Delayed ZOL therapy was estimated to cost £16069 per QALY, when compared with not administering bisphosphonates for AIBL prevention. The corresponding cost per QALY gained for upfront ZOL versus no treatment was estimated at £21973. The cost-effectiveness ratio for upfront versus delayed therapy was estimated at £24868 per QALY gained. Both delayed and upfront therapy with ZOL for the prevention of AIBL and fractures in BC patients in the UK appear to result in highly acceptable cost-effectiveness ratios.