Cost-effectiveness of zoledronic acid vs clodronic acid for newly-diagnosed multiple myeloma from the United Kingdom healthcare system perspective.
OBJECTIVE
In the Medical Research Council Myeloma IX Study (MMIX), zoledronic acid (ZOL) 4 mg 3-4/week reduced the incidence of skeletal-related events (SREs), increased progression free survival (PFS), and prolonged overall survival (OS), compared with clodronic acid (CLO) 1600 mg daily, in 1970 patients with newly-diagnosed multiple myeloma (MM).


METHODS
An economic model was used to project PFS, OS, the incidence of SREs and adverse events and expected lifetime healthcare costs for patients with newly-diagnosed MM who are alternatively assumed to receive ZOL or CLO. The incremental cost-effectiveness ratio [ICER] of ZOL vs CLO was calculated as the ratio of the difference in cost to the difference in quality-adjusted life years (QALYs). Model inputs were based on results of MMIX and published sources.


RESULTS
Compared with CLO, treatment with ZOL increases QALYs by 0.30 at an additional cost of £1653, yielding an ICER of £5443 per QALY gained. If the threshold ICER is £20,000 per QALY, the estimated probability that ZOL is cost-effective is 90%.


CONCLUSIONS
The main limitation of this study is the lack of data on the effects of zoledronic acid on survival beyond the end of follow-up in the MMIX trial. However, cost-effectiveness was favourable even under the highly conservative scenario in which the timeframe of the model was limited to 5 years.


CONCLUSIONS
Compared with clodronic acid, zoledronic acid represents a cost-effective treatment alternative in patients with multiple myeloma.
PAI (Policy Analysis Inc.) Brookline, MA, USA. tdelea@pai2.com
Thomas E
TE
Delea
Jason
J
Rotter
Matthew
M
Taylor
David
D
Chandiwana
Manjinder
M
Bains
Khalid
K
El Ouagari
Satyin
S
Kaura
Gareth J
GJ
Morgan
D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D004002:Clodronic Acid / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics*; D004164:Diphosphonates / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D018803:Models, Economic; D009101:Multiple Myeloma / Q000188:drug therapy*; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D006113:United Kingdom; D000077211:Zoledronic Acid
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D004002:Clodronic Acid; D000077211:Zoledronic Acid