Lazaros Andronis1,2, Ilias Goranitis3, Sue Bayliss4, Rui Duarte5. 1. Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK. l.andronis@warwick.ac.uk. 2. Office A.103, Populations, Evidence and Technologies Group, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK. l.andronis@warwick.ac.uk. 3. Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK. 4. Institute of Applied Health Research, University of Birmingham, Birmingham, UK. 5. Liverpool Reviews and Implementation Group, Department of Health Services Research, University of Liverpool, Liverpool, UK.
Abstract
BACKGROUND: Metastatic cancers occur when cancer cells break away from the primary tumour. One of the most common sites of metastasis is the bone, with several therapeutic options currently available for managing bone metastases. In a resource-constrained environment, policy makers and practitioners need to know which options are cost effective. OBJECTIVE: The aim of this systematic review was to review and appraise published economic evaluations on treatments for the management of bone metastases. METHODS: We searched eight bibliographic databases (MEDLINE, MEDLINE in Process, EMBASE, CSDR, DARE, HTA, EED and CPCI) for relevant economic evaluations published from each database's inception date until March 2017. Study selection, quality assessment and data extraction were carried out according to published guidelines. RESULTS: Twenty-four relevant economic analyses were identified. Seventeen of these studies focused on bone metastases resulting from a particular type of cancer, i.e. prostate (n = 8), breast (n = 7), lung (n = 1) or renal (n = 1), while seven report results for various primary tumours. Across types of cancer, evidence suggests that bisphosphonates result in lower morbidity and improved quality of life, for an additional cost, which is typically below conventional cost-effectiveness thresholds. While denosumab leads to health gains compared with zoledronic acid, it also results in substantial additional costs and is unlikely to represent value for money. The limited literature on the radiopharmaceutical strontium-89 (Sr89) and external beam radiotherapy (EBR) suggest that these treatments are cost effective compared with no treatment. CONCLUSIONS: The reviewed evidence suggests that bisphosphonate treatments are cost-effective options for bone metastases, while denosumab is unlikely to represent value for money. Evidence on EBR and Sr89 is limited and less conclusive.
BACKGROUND:Metastatic cancers occur when cancer cells break away from the primary tumour. One of the most common sites of metastasis is the bone, with several therapeutic options currently available for managing bone metastases. In a resource-constrained environment, policy makers and practitioners need to know which options are cost effective. OBJECTIVE: The aim of this systematic review was to review and appraise published economic evaluations on treatments for the management of bone metastases. METHODS: We searched eight bibliographic databases (MEDLINE, MEDLINE in Process, EMBASE, CSDR, DARE, HTA, EED and CPCI) for relevant economic evaluations published from each database's inception date until March 2017. Study selection, quality assessment and data extraction were carried out according to published guidelines. RESULTS: Twenty-four relevant economic analyses were identified. Seventeen of these studies focused on bone metastases resulting from a particular type of cancer, i.e. prostate (n = 8), breast (n = 7), lung (n = 1) or renal (n = 1), while seven report results for various primary tumours. Across types of cancer, evidence suggests that bisphosphonates result in lower morbidity and improved quality of life, for an additional cost, which is typically below conventional cost-effectiveness thresholds. While denosumab leads to health gains compared with zoledronic acid, it also results in substantial additional costs and is unlikely to represent value for money. The limited literature on the radiopharmaceutical strontium-89 (Sr89) and external beam radiotherapy (EBR) suggest that these treatments are cost effective compared with no treatment. CONCLUSIONS: The reviewed evidence suggests that bisphosphonate treatments are cost-effective options for bone metastases, while denosumab is unlikely to represent value for money. Evidence on EBR and Sr89 is limited and less conclusive.
Authors: Nicholas James; Sarah Pirrie; Ann Pope; Darren Barton; Lazaros Andronis; Ilias Goranitis; Stuart Collins; Duncan McLaren; Joe O'Sullivan; Chris Parker; Emilio Porfiri; John Staffurth; Andrew Stanley; James Wylie; Sharon Beesley; Alison Birtle; Janet Brown; Prabir Chakraborti; Martin Russell; Lucinda Billingham Journal: Health Technol Assess Date: 2016-07 Impact factor: 4.014
Authors: Erwin De Cock; John Hutton; Peter Canney; J J Body; Peter Barrett-Lee; Maureen P Neary; Gavin Lewis Journal: Clin Ther Date: 2005-08 Impact factor: 3.393
Authors: Lee S Rosen; David Gordon; Simon Tchekmedyian; Ronald Yanagihara; Vera Hirsh; M Krzakowski; M Pawlicki; Paul de Souza; Ming Zheng; Gladys Urbanowitz; Dirk Reitsma; John J Seaman Journal: J Clin Oncol Date: 2003-08-15 Impact factor: 44.544
Authors: Lee S Rosen; David Gordon; N Simon Tchekmedyian; Ronald Yanagihara; Vera Hirsh; Maciej Krzakowski; Marek Pawlicki; Paul De Souza; Ming Zheng; Gladys Urbanowitz; Dirk Reitsma; John Seaman Journal: Cancer Date: 2004-06-15 Impact factor: 6.860
Authors: Julia Simões Corrêa Galendi; Sin Yuin Yeo; Holger Grüll; Grischa Bratke; Dennis Akuamoa-Boateng; Christian Baues; Clemens Bos; Helena M Verkooijen; Arim Shukri; Stephanie Stock; Dirk Müller Journal: Front Oncol Date: 2022-09-23 Impact factor: 5.738