Cost-effectiveness of zoledronic acid vs clodronic acid for newly-diagnosed multiple myeloma from the United Kingdom healthcare system perspective

Abstract

Objective:

In the Medical Research Council Myeloma IX Study (MMIX), zoledronic acid (ZOL) 4 mg 3–4/week reduced the incidence of skeletal-related events (SREs), increased progression free survival (PFS), and prolonged overall survival (OS), compared with clodronic acid (CLO) 1600 mg daily, in 1970 patients with newly-diagnosed multiple myeloma (MM).

Methods:

An economic model was used to project PFS, OS, the incidence of SREs and adverse events and expected lifetime healthcare costs for patients with newly-diagnosed MM who are alternatively assumed to receive ZOL or CLO. The incremental cost-effectiveness ratio [ICER] of ZOL vs CLO was calculated as the ratio of the difference in cost to the difference in quality-adjusted life years (QALYs). Model inputs were based on results of MMIX and published sources.

Results:

Compared with CLO, treatment with ZOL increases QALYs by 0.30 at an additional cost of £1653, yielding an ICER of £5443 per QALY gained. If the threshold ICER is £20,000 per QALY, the estimated probability that ZOL is cost-effective is 90%.

Limitations:

The main limitation of this study is the lack of data on the effects of zoledronic acid on survival beyond the end of follow-up in the MMIX trial. However, cost-effectiveness was favourable even under the highly conservative scenario in which the timeframe of the model was limited to 5 years.

Conclusions:

Compared with clodronic acid, zoledronic acid represents a cost-effective treatment alternative in patients with multiple myeloma.

Key words::

• Multiple myeloma
• Zoledronic acid
• Cost-effectiveness

Transparency

Declaration of funding

Funding for this research was provided to PAI (Policy Analysis Inc.) by Novartis Pharmaceuticals Corp.

Disclosure of financial/other relationships

Thomas E. Delea and Jason Rotter are employees of Policy Analysis Inc. (PAI), which has received research funding and consulting fees from Novartis. David Chandiwana, Manjinder Bains, and Khalid El Ouagari are employees of Novartis and own stock and/or stock options in Novartis. Satyin Kaura was an employee of Novartis at the time this research was conducted and owns stock and/or stock options in Novartis.

Acknowledgements

We thank Alex J Szubert for his assistance in providing information from MRC Myeloma IX trial.