Cost-effectiveness of fracture prevention in men who receive androgen deprivation therapy for localized prostate cancer.
Ann Intern Med
; 152(10): 621-9, 2010 May 18.
Article
en En
| MEDLINE
| ID: mdl-20479027
ABSTRACT
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.DESIGN:
Markov state-transition model simulating the progression of prostate cancer and the incidence of hip fracture. DATA SOURCES Published literature. TARGET POPULATION 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. TIME HORIZON Lifetime. PERSPECTIVE Societal. INTERVENTION 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. OUTCOMEMEASURES:
Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained. RESULTS OF BASE-CASEANALYSIS:
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 OF SENSITIVITY ANALYSES 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.LIMITATIONS:
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.CONCLUSION:
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.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Neoplasias de la Próstata
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Orquiectomía
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Alendronato
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Conservadores de la Densidad Ósea
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Fracturas de Cadera
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Antagonistas de Andrógenos
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Antineoplásicos
Tipo de estudio:
Etiology_studies
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Health_economic_evaluation
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Aged80
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Ann Intern Med
Año:
2010
Tipo del documento:
Article
País de afiliación:
Estados Unidos