Cost-effectiveness of denosumab (D) versus zoledronic acid (Z) for skeletal-related event (SRE) reduction in bone-metastatic prostate cancer (mPC) in the United Kingdom.
e15189 Background: D reduced SREs vs Z in a phase III trial, but no significant differences in overall survival, disease progression, or serious adverse events were reported. The cost-effectiveness of D vs Z in mPC was assessed from a UK payer perspective. Methods: A literature-based Markov model estimated quality-adjusted life-years (QALYs), number and costs of SREs, and drug/administration costs for mPC pts receiving D or Z for 27 mo (trial timeframe) and 60 mo (extended lifetime analysis). Current list prices/injection (£309.86 for D; £174.14 for Z) were used in the base case. As the model’s analytical horizon starts June 2012 and extends beyond generic Z availability in May 2013, a generic Z price (53% < list price, per data for other now-generic bisphosphonates) was used beyond May 2013 in scenario analysis. In other analyses, discounted prices (–30%) were used for both D and Z to assess the effect of price reductions on cost/QALY. Clinical inputs were selected to reproduce trial outcomes. QALYs were estimated by assigning utility weights to time spent in health states (no SRE; SRE; post-SRE; death). SRE costs were £250 to ≥ £6,000/event. Results: Although D may result in fewer SREs, higher QALYs, and lower SRE-related costs (Table), higher acquisition cost of D results in substantially higher costs and may be cost-ineffective in every pricing scenario. Similar results were found for the 27-mo analysis. Conclusions: The incremental cost/QALY gained with D vs Z ranged from £50,000 to £215,000 (> traditional £30,000 threshold), thus raising important questions about D’s value in mPC. [Table: see text]