title: Cost effectiveness of zoledronic acid in the management of skeletal metastases in hormone-refractory prostate cancer patients in France, Germany, Portugal, and the Netherlands.
abstract: OBJECTIVE
  Zoledronic acid (ZOL) reduces the risk of skeletal related events (SREs) in hormone-refractory prostate cancer (HRPC) patients with bone metastases. This study assessed the cost effectiveness of ZOL for SRE management in French, German, Portuguese, and Dutch HRPC patients.
  
  
  METHODS
  This analysis was based on the results of a randomized phase III clinical trial wherein HRPC patients received up to 15 months of ZOL (n = 214) or placebo (n = 208). Clinical inputs were obtained from the trial. Costs were estimated using hospital tariffs, published, and internet sources. Quality adjusted life-years (QALYs) gained were estimated from a separate analysis of EQ-5D scores reported in the trial. Uncertainty surrounding outcomes was addressed via univariate sensitivity analyses.
  
  
  RESULTS
  ZOL patients experienced an estimated 0.759 fewer SREs and gained an estimated 0.03566 QALYs versus placebo patients. ZOL was associated with reduced SRE-related costs [net costs] (-€2396 [€1284] in France, -€2606 [€841] in Germany, -€3326 [€309] in Portugal and -€3617 [€87] in the Netherlands). Costs per QALY ranged from €2430 (Netherlands) to €36,007 (France).
  
  
  CONCLUSIONS
  This analysis is subject to the limitations of most cost-effectiveness analyses: it combines data from multiple sources. Nevertheless, the results strongly suggest that ZOL is cost effective versus placebo in French, German, Portuguese, and Dutch HRPC patients.
authors.affiliation: Pharmerit International-Health Economics, Pharmerit North America LLC, 7272 Wisconsin Ave. #300, Bethesda, MD, USA. jcarter@pharmerit.com
authors.forename: J A
authors.initials: JA
authors.lastname: Carter
authors.forename: A
authors.initials: A
authors.lastname: Joshi
authors.forename: S
authors.initials: S
authors.lastname: Kaura
authors.forename: M F
authors.initials: MF
authors.lastname: Botteman
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000191:economics*; D001859:Bone Neoplasms / Q000556:secondary*; D001842:Bone and Bones / Q000187:drug effects* / Q000503:physiopathology; D003362:Cost-Benefit Analysis; D004164:Diphosphonates / Q000008:administration & dosage / Q000191:economics*; D005060:Europe; D017048:Health Care Costs / Q000639:trends*; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000191:economics*; D008297:Male; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D006728:Hormones; D007093:Imidazoles; D000077211:Zoledronic Acid