Botteman M, Barghout V, Stephens J, Hay J, Brandman J, Aapro M
Pharmerit, Bethesda, MD 20814, USA.
Ann Oncol. 2006 Jul;17(7):1072-82. doi: 10.1093/annonc/mdl093. Epub 2006 May 2.
Bisphosphonates are recommended to prevent skeletal related events (SREs) in patients with breast cancer and bone metastases (BCBM). However, their clinical and economic profiles vary from one agent to the other.
Using modeling techniques, we simulated from the perspective of the UK's National Health Service (NHS) the cost and quality adjusted survival (QALY) associated with five commonly-used bisphosphonates or no therapy in this patient population. The simulation followed patients into several health states (i.e. alive or dead, experiencing an SRE or no SRE, and receiving first or second line therapy). Drugs costs, infusion costs, SREs costs, and utility values were estimated from published sources. Utilities were applied to time with and without SREs to capture the impact on quality of life.
Compared to no therapy, all bisphosphonates are either cost saving or highly cost-effective (with a cost per QALY < or = 6126 pounds sterlings). Within this evaluation, zoledronic acid was more effective and less expensive than all other options.
Based on our model, the use of bisphosphonates in breast cancer patients with bone metastases should lead to improved patient outcomes and cost savings to the NHS and possibly other similar entities.
双膦酸盐类药物被推荐用于预防乳腺癌骨转移（BCBM）患者的骨相关事件（SREs）。然而，不同药物的临床和经济学特征存在差异。
我们采用建模技术，从英国国家医疗服务体系（NHS）的角度模拟了在该患者群体中，使用五种常用双膦酸盐类药物或不进行治疗所产生的成本及质量调整生存期（QALY）。该模拟跟踪患者进入多种健康状态（即存活或死亡、发生或未发生SRE、接受一线或二线治疗）。药物成本、输注成本、SREs成本及效用值均根据已发表资料估算。将效用值应用于发生和未发生SREs的时间段，以反映对生活质量的影响。
与不进行治疗相比，所有双膦酸盐类药物均具有成本节约或高成本效益（每QALY成本≤6126英镑）。在此评估中，唑来膦酸比所有其他选择更有效且成本更低。
基于我们的模型，在乳腺癌骨转移患者中使用双膦酸盐类药物应能改善患者预后，并为NHS及其他类似机构节省成本。
