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Cost-Effectiveness of Treatments for the Management of Bone Metastases: A Systematic Literature Review

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  • Lazaros Andronis

    (University of Birmingham
    University of Warwick)

  • Ilias Goranitis

    (University of Birmingham)

  • Sue Bayliss

    (University of Birmingham)

  • Rui Duarte

    (University of Liverpool)

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.

Suggested Citation

  • Lazaros Andronis & Ilias Goranitis & Sue Bayliss & Rui Duarte, 2018. "Cost-Effectiveness of Treatments for the Management of Bone Metastases: A Systematic Literature Review," PharmacoEconomics, Springer, vol. 36(3), pages 301-322, March.
    • Handle: RePEc:spr:pharme:v:36:y:2018:i:3:d:10.1007_s40273-017-0595-0
    DOI: 10.1007/s40273-017-0595-0
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    1. Brazier, John & Ratcliffe, Julie & Salomon, Joshua & Tsuchiya, Aki, 2016. "Measuring and Valuing Health Benefits for Economic Evaluation," OUP Catalogue, Oxford University Press, edition 2, number 9780198725923.
    2. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
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    1. Jessica Y. Matuoka & James G. Kahn & Silvia R. Secoli, 2019. "Denosumab versus bisphosphonates for the treatment of bone metastases from solid tumors: a systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(4), pages 487-499, June.

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