A cost-effectiveness analysis of denosumab for the prevention of skeletal-related events in patients with multiple myeloma in the United States of America
Open accessAbstract
OBJECTIVE: A large, pivotal, phase 3 trial in patients with newly diagnosed multiple myeloma (MM) demonstrated that denosumab, compared with zoledronic acid, was non-inferior for the prevention of skeletal-related events (SREs), extended the observed median progression-free survival (PFS) by 10.7 months, and showed significantly less renal toxicity. The cost-effectiveness of denosumab vs zoledronic acid in MM in the US was assessed from societal and payer perspectives. METHODS: The XGEVA Global Economic Model was developed by integrating data from the phase 3 trial comparing the efficacy of denosumab with zoledronic acid for the prevention of SREs in MM. SRE rates were adjusted to reflect the real-world incidence. The model included utility decrements for SREs, administration, serious adverse events (SAEs), and disease progression. Drug, administration, SRE management, SAEs, and anti-MM treatment costs were based on data from published studies. For the societal perspective, the model additionally included SRE-related direct non-medical costs and indirect costs. The net monetary benefit (NMB) was calculated using a willingness-to-pay threshold of US$150,000. One-way deterministic and probabilistic sensitivity analyses were conducted. RESULTS: From a societal perspective, compared with zoledronic acid, the use of denosumab resulted in an incremental cost of US$26,329 and an incremental quality-adjusted life-year (QALY) of 0.2439, translating into a cost per QALY gained of US$107,939 and a NMB of US$10,259 in favor of denosumab. Results were sensitive to SRE rates and PFS parameters. LIMITATIONS: Costs were estimated from multiple sources, which varied by tumor type, patient population, country, and other parameters. PFS and overall survival were extrapolated beyond the follow-up of the primary analysis using fitted parametric curves. CONCLUSION: Denosumab's efficacy in delaying or preventing SREs, potential to improve PFS, and lack of renal toxicity make it a cost-effective option for the prevention of SREs in MM compared with zoledronic acid.
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Bisphosphonates such as zoledronic acid, or bone-stimulating agents like denosumab, are recommended upon diagnosis in order to prevent or palliate lytic lesions and fractures.
“Other treatment considerations, including bisphosphonates, such as zoledronic acid, or bone-stimulating agents (BSAs), like denosumab, are recommended upon diagnosis in order to prevent or palliate lytic lesions and fractures [42,43].”
From Epidemiology, Staging, and Management of Multiple Myeloma (2021) · cites this paper as [43]
The Introduction (page not provided) says guidelines recommend starting therapy to prevent skeletal-related events alongside antimyeloma treatment for active multiple myeloma; it identifies zoledronic acid as the former standard of care and denosumab as approved for prevention. Fractures are among the events described, but the paper does not say denosumab is specifically recommended upon diagnosis or that either drug palliates existing lytic lesions. (LLM, conf=0.84)
Experimental — accuracy not yet measuredEight other publications were identified that report relative time or cost information for IV versus SC administration.
“In addition to the publications regarding trastuzumab and rituximab, eight other publications were identified that report relative time or cost information for IV versus SC administration (Table 2) [112–119]”
From A systematic review of time and resource use costs of subcutaneous versus intravenous administration of oncology biologics in a hospital setting (2023) · cites this paper as [114]
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“Other treatment considerations, including bisphosphonates, such as zoledronic acid, or bone-stimulating agents (BSAs), like denosumab, are recommended upon diagnosis in order to prevent or palliate lytic lesions and fractures [42,43].”
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- Authors
- Raje, N., Roodman, G. D., Willenbacher, W., Shimizu, K., García-Sanz, R., Terpos, E., Kennedy, L., Sabatelli, L., Intorcia, M., & Hechmati, G.
- Affiliations
- Massachusetts General Hospital (US)
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center (US)
- Innsbruck Medical University (AT)
- National Hospital Organization (JP)
- Hospital Universitario de Salamanca, Salamanca, Spain;
- National and Kapodistrian University of Athens (GR)
- Epiphany, Los Angeles, CA, USA;
- Amgen (Switzerland) (CH)
- Amgen (United States) (US)
- Corresponding author
- Intorcia, Michele
- Venue
- Journal of Medical Economics
- Publisher
- Informa UK Limited
- Published
- 2018-03-05
- Volume
- 21
- Issue
- 5
- Pages
- 525-536
- ISSN
- 1369-6998 (ISSN-L)
- 1941-837X
- OpenAlex
- W2789852769
- Cited by
- 25
- References
- 54
- Citations by year
- 2026: 2 · 2025: 2 · 2023: 1 · 2022: 5 · 2021: 8 · 2020: 3 · 2019: 4
- FWCI
- 1.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Medical Economics (publishedVersion)
- PubMed (publishedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Author eBooks
- Funders
- Amgen, Inc.
- Topics
- Health Sciences › Medicine › Oncology › Bone health and treatments
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Hematology › Multiple Myeloma Research and Treatments
- Keywords
- denosumab, multiple myeloma, skeletal-related events, zoledronic acid, cost-effectiveness, economic models, quality-adjusted life years, progression-free survival, nephrotoxicity, net monetary benefit, societal perspective, indirect costs
- MeSH terms
- Denosumab, Zoledronic Acid, Bone Diseases, Bone Neoplasms, Cost-Benefit Analysis, Diphosphonates, Health Expenditures, Female, Humans, Imidazoles, Male, Multiple Myeloma, United States, Survival Analysis, Cost of Illness, Models, Economic, Quality-Adjusted Life Years, Bone Density Conservation Agents
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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