title: Cost-effectiveness of zoledronic acid and strontium-89 as bone protecting treatments in addition to chemotherapy in patients with metastatic castrate-refractory prostate cancer: results from the TRAPEZE trial (ISRCTN 12808747).
abstract: To evaluate the cost-effectiveness of adding zoledronic acid or strontium-89 to standard docetaxel chemotherapy for patients with castrate-refractory prostate cancer (CRPC).
  
  
  
  Data on resource use and quality of life for 707 patients collected prospectively in the TRAPEZE 2 × 2 factorial randomised trial (ISRCTN 12808747) were used to assess the cost-effectiveness of i) zoledronic acid versus no zoledronic acid (ZA vs. no ZA), and ii) strontium-89 versus no strontium-89 (Sr89 vs. no Sr89). Costs were estimated from the perspective of the National Health Service in the UK and included expenditures for trial treatments, concomitant medications, and use of related hospital and primary care services. Quality-adjusted life-years (QALYs) were calculated according to patients' responses to the generic EuroQol EQ-5D-3L instrument, which evaluates health status. Results are expressed as incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves.
  
  
  
  The per-patient cost for ZA was £12 667, £251 higher than the equivalent cost in the no ZA group. Patients in the ZA group had on average 0.03 QALYs more than their counterparts in no ZA group. The ICER for this comparison was £8 005. Sr89 was associated with a cost of £13 230, £1365 higher than no Sr89, and a gain of 0.08 QALYs compared to no Sr89. The ICER for Sr89 was £16 884. The probabilities of ZA and Sr89 being cost-effective were 0.64 and 0.60, respectively.
  
  
  
  The addition of bone-targeting treatments to standard chemotherapy led to a small improvement in QALYs for a modest increase in cost (or cost-savings). ZA and Sr89 resulted in ICERs below conventional willingness-to-pay per QALY thresholds, suggesting that their addition to chemotherapy may represent a cost-effective use of resources.
authors.affiliation: Health Economics Unit, University of Birmingham, Birmingham, UK.
authors.forename: Lazaros
authors.identifier: 0000-0001-7998-7431
authors.initials: L
authors.lastname: Andronis
authors.affiliation: Health Economics Unit, University of Birmingham, Birmingham, UK.
authors.forename: Ilias
authors.initials: I
authors.lastname: Goranitis
authors.affiliation: Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pirrie
authors.affiliation: Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Pope
authors.affiliation: Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK.
authors.forename: Darren
authors.initials: D
authors.lastname: Barton
authors.affiliation: Posthumously listed (previously CRCTU Birmingham), Birmingham, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Collins
authors.affiliation: University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Daunton
authors.affiliation: Western General Hospital, Edinburgh, UK.
authors.forename: Duncan
authors.initials: D
authors.lastname: McLaren
authors.affiliation: Belfast City Hospital, Belfast, UK.
authors.forename: Joe M
authors.initials: JM
authors.lastname: O'Sullivan
authors.affiliation: Royal Marsden Hospital, London, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Parker
authors.affiliation: University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Emilio
authors.initials: E
authors.lastname: Porfiri
authors.affiliation: Institute of Cancer and Genetics, Cardiff University, UK.
authors.forename: John
authors.initials: J
authors.lastname: Staffurth
authors.affiliation: City Hospital, Birmingham, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Stanley
authors.affiliation: The Christie Hospital, Manchester, UK.
authors.forename: James
authors.initials: J
authors.lastname: Wylie
authors.affiliation: Kent Oncology Centre, Maidstone, Kent, UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Beesley
authors.affiliation: Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Birtle
authors.affiliation: St James' University Hospital, Leeds, UK.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Brown
authors.affiliation: Royal Derby Hospital, Derby, UK.
authors.forename: Prabir
authors.initials: P
authors.lastname: Chakraborti
authors.affiliation: University of Liverpool, Liverpool, UK.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Hussain
authors.affiliation: Beatson West of Scotland Cancer Centre, Glasgow, UK.
authors.forename: J Martin
authors.initials: JM
authors.lastname: Russell
authors.affiliation: Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK.
authors.forename: Lucinda J
authors.initials: LJ
authors.lastname: Billingham
authors.affiliation: University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: James
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols; D050071:Bone Density Conservation Agents / Q000191:economics* / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000191:economics / Q000556:secondary*; D003362:Cost-Benefit Analysis; D004164:Diphosphonates / Q000627:therapeutic use*; D018572:Disease-Free Survival; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy* / Q000473:pathology*; D011788:Quality of Life; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D013324:Strontium / Q000627:therapeutic use*; D006113:United Kingdom; D000077211:Zoledronic Acid
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D019275:Radiopharmaceuticals; D000077211:Zoledronic Acid; D013324:Strontium
keywords: Sr89; bone protecting treatments; castrate-refractory prostate cancer; cost-effectiveness analysis; quality of life; zoledronic acid