Pharmacoeconomic issues in bisphosphonate treatment of metastatic bone disease

Bisphosphonates provide a supportive benefit to patients with bone metastases from cancer by reducing skeletal complications, such as bone pain, pathologic fractures, and hypercalcemia. Although bisphosphonates have important therapeutic effects, such as significant improvements in the quality of remaining life, they do not, as yet, significantly improve the overall survival of affected patients. Furthermore, as with all new innovations, they exert a major impact on drug budgets dedicated for cancer care. Further research is warranted to identify clinical predictors of the optimum time in the course of the disease to start and stop therapy, to integrate use of bisphosphonates with other therapies, to identify their role in the adjuvant setting, and to determine their cost-benefit consequences. Current cost-effectiveness assessments have shown that the incremental costs per skeletal-related event are particularly sensitive to the unit price of the bisphosphonate modeled. Therefore, pharmacoeconomic evaluations should be combined with clinical trials to predict accurately the true costs (total resource usage) of this health care intervention and to ultimately assess the rational broad use of these agents.