Fracture prevention therapy was cost-effective for locally advanced prostate cancer

Screening for bone mineral density prior to adjuvant chemotherapy was “reasonably cost-effective” in a hypothetical cohort of elderly men with locally advanced or high-risk localized prostate cancer.

Researchers with Memorial Sloan-Kettering Cancer Center said that study results supported the American College of Physicians’ recommendation that screening men who are younger than 80 years for osteoporosis would only be cost-effective if they are at increased risk for the condition or candidates for androgen deprivation therapy.

Specifically, the researchers concluded that it was cost effective for men with cancer aged 70 years who had been diagnosed with osteoporosis to undergo a bone mineral density test before adjuvant ADT followed by selective alendronate therapy.

In the study, researchers created a simulated cohort of men aged 70 years with locally advanced or high-risk localized prostate cancer. The patients were starting a two-year course of ADT after radiation therapy.

Researchers tested three screening strategies on the cohort: no bone mineral density screening, a one-time test before beginning ADT followed by selective alendronate therapy for patients without osteoporosis, and universal alendronate therapy without a bone mineral density screen.

Compared with the no test-no alendronate strategy, researchers said a bone mineral density test followed by selective alendronate therapy was both more costly and more effective with an incremental cost-effectiveness ratio of $66,800 per quality-adjusted life year gained.

Universal alendronate therapy was even more effective, but the incremental cost-effectiveness ratio was $178,700 per quality-adjusted life year gained. However, if it was assumed that patients were older, had a history of fractures, had a lower mean bone mineral density prior to ADT, or that alendronate had a lower cost, the incremental cost-effectiveness ratio for universal alendronate decreased to $100,000 per quality-adjusted life year gained.

“These results are encouraging and suggest that prevention of bone loss with alendronate is cost-effective when treatment is targeted to patients at high risk for fractures,” the researchers wrote.

Ito K. Ann Intern Med. 2010;152:621-629.