The Use of Bisphosphonates in Patients With Breast Cancer

Catherine H. Van Poznak, MD

Disclosures

Cancer Control. 2002;9(6) 

In This Article

Pharmacoeconomics

Bisphosphonates have been shown to decrease the frequency of hypercalcemia of malignancy, the need for radiation to bone, and the rate of vertebral fractures. Theoretically, this clinical benefit would be expected to translate into a cost benefit for patients receiving bisphosphonates; however, this potential cost benefit has not yet been documented. There is a lack of prospective cost effectiveness studies, and much of the data have been generated through modeling. In a model based on the pivotal phase III pamidronate trials, the cost associated with pamidronate use exceeded the cost of avoiding skeletal-related events.[48] In a separate study, the costs associated with pamidronate vs zoledronic acid were examined. This microcosting analysis demonstrated the potential for zoledronic acid to result in a reduction in the patient visit time and in nurse labor costs[49]; cost effectiveness was not investigated in this study.

The existing cost effectiveness data are difficult to apply across different healthcare systems. Also, the existing data do not take into account pain or quality of life, which are key endpoints when treating for palliation. In spite of the questionable cost effectiveness, bisphosphonates remain an integral part of the treatment of lytic breast cancer metastases. Prospective studies to identify subgroups of patients most likely to benefit (or not) from bisphosphonate treatment are need to tailor therapy to the individual patient.

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