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

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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.

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Authors and Affiliations

  1. Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK

    Lazaros Andronis & Ilias Goranitis

  2. Office A.103, Populations, Evidence and Technologies Group, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK

    Lazaros Andronis

  3. Institute of Applied Health Research, University of Birmingham, Birmingham, UK

    Sue Bayliss

  4. Liverpool Reviews and Implementation Group, Department of Health Services Research, University of Liverpool, Liverpool, UK

    Rui Duarte

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  1. Lazaros Andronis
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  2. Ilias Goranitis
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  4. Rui Duarte
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Contributions

LA, IG and RD contributed to the study conception and design, article selection, data extraction, data interpretation and manuscript preparation. SB contributed to the study conception, designed and conducted search strategies, retrieved identified articles and contributed to manuscript preparation. All authors approved the final version of this article.

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Correspondence to Lazaros Andronis.

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Conflict of interest

Lazaros Andronis, Ilias Goranitis, Sue Bayliss and Rui Duarte declare no conflicts of interest.

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No funding has been received for this study.

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Andronis, L., Goranitis, I., Bayliss, S. et al. Cost-Effectiveness of Treatments for the Management of Bone Metastases: A Systematic Literature Review. PharmacoEconomics 36, 301–322 (2018). https://doi.org/10.1007/s40273-017-0595-0

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