Cost-effectiveness of fracture prevention in men who receive androgen deprivation therapy for localized prostate cancer.
BACKGROUND
Androgen deprivation therapy (ADT) increases the risk for fractures in patients with prostate cancer.


OBJECTIVE
To assess the cost-effectiveness of measuring bone mineral density (BMD) before initiating ADT followed by alendronate therapy in men with localized prostate cancer.


METHODS
Markov state-transition model simulating the progression of prostate cancer and the incidence of hip fracture.


METHODS
Published literature.


METHODS
A hypothetical cohort of men aged 70 years with locally advanced or high-risk localized prostate cancer starting a 2-year course of ADT after radiation therapy.


METHODS
Lifetime.


CONCLUSIONS
Societal.


METHODS
No BMD test or alendronate therapy, a BMD test followed by selective alendronate therapy for patients with osteoporosis, or universal alendronate therapy without a BMD test.


METHODS
Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained.


RESULTS
The ICERs for the strategy of a BMD test and selective alendronate therapy for patients with osteoporosis and universal alendronate therapy without a BMD test were $66,800 per QALY gained and $178,700 per QALY gained, respectively.


RESULTS
The ICER for universal alendronate therapy without a BMD test decreased to $100,000 per QALY gained, assuming older age, a history of fractures, lower mean BMD before ADT, or a lower cost of alendronate.


CONCLUSIONS
No evidence shows that alendronate reduces actual fracture rates in patients with prostate cancer who receive ADT. The model predicted fracture rates by using data on the surrogate BMD end point.


CONCLUSIONS
In patients starting adjuvant ADT for locally advanced or high-risk localized prostate cancer, a BMD test followed by selective alendronate for those with osteoporosis is a cost-effective use of resources. Routine use of alendronate without a BMD test is justifiable in patients at higher risk for hip fractures.
Ito
Kouta
K
Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Elkin
Elena B
EB
Girotra
Monica
M
Morris
Michael J
MJ
D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects / Q000627:therapeutic use*; D000726:Androgen Antagonists / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006620:Hip Fractures / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009919:Orchiectomy / Q000009:adverse effects*; D010024:Osteoporosis / Q000150:complications; D011471:Prostatic Neoplasms / Q000503:physiopathology / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D012307:Risk Factors
D000726:Androgen Antagonists; D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D007987:Gonadotropin-Releasing Hormone; D019386:Alendronate