Clinical and economic issues in the treatment of advanced breast cancer with bisphosphonates.
An ideal palliative therapy for bone metastases would successfully reduce skeletal complications in several thousands of breast cancer patients. Second- and third-generation bisphosphonates are effective in reducing the overall skeletal complication rate and the time to first skeletal complication. Nevertheless, not enough evidence supports their benefit on quality of life. Furthermore, bisphosphonates are expensive (up to 775 US dollars per month, 2002 value) and cost-effectiveness evaluations have been limited to pamidronate (pamidronic acid). In economic evaluations of pamidronate, resulting incremental dollar per quality-adjusted life year gained ranged from cost savings to 108,000 US dollars per quality-adjusted life year. The data were quite sensitive to quality-of-life estimates and country-specific cost values. Because of the wide range of the cost-effectiveness ratio, it is uncertain whether the universal prescription of bisphosphonates in this setting represents an efficient use of healthcare resources. Probably, country- and drug-specific policies might increase the efficiency of this treatment. Further outcomes research is required to assess these agents more fully.
Liberato
Nicola Lucio
NL
Division of Internal Medicine, Civil Hospital, Voghera, Italy. lucio_liberato@asl.pavia.it
Marchetti
Monia
M
Barosi
Giovanni
G
D001859:Bone Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000556:secondary*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D002170:Canada; D003362:Cost-Benefit Analysis; D004164:Diphosphonates / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
D004164:Diphosphonates