Presentation (CTI)

OBJECTIVES: Bone metastases are common approximately 65-75% of patients with breast and prostate cancer and 15-40% of those with lung cancer, colon cancer, or multiple myeloma develop bone metastases. Bisphosphonates and the denosumab are the primary treatments used to prevent skeletal-related events (SREs); however, the cost-effectiveness of denosumab remains uncertain. This systematic review evaluated the published economic evidence on denosumab for the management of cancer patients with bone metastases.
METHODS: A systematic literature search was performed across Embase, PubMed, and Google-Scholar databases to identify original articles published between 2016-2026. Keywords consisted of "cost-effectiveness analysis, "denosumab", "bone metastases", "multiple myeloma", "ICER" and "QALY" in the search strategy. Quality assessment of the included studies was assessed using the 36-item Drummond checklist.
RESULTS: A total of eight relevant economic evaluation studies were identified. Six studies (n=6) evaluated patients with solid tumours with bone metastases, including breast cancer, prostate cancer/castration-resistant prostate cancer (CRPC), and mixed solid tumours such as breast, prostate, lung, renal, and other solid tumour cancers. Two studies (n=2) evaluated patients with non-solid tumours/haematological malignancies, specifically multiple myeloma. Five studies used Markov models, one used a hybrid model (partitioned survival + semi-Markov model), one used a partitioned survival model, and one used a decision tree model. Cost-effectiveness analyses were conducted from societal and payer perspectives (n=2), payer perspectives including the US payer perspective (n=2), and healthcare system/national healthcare payer perspectives (n=4). The most commonly reported health states were on treatment, off treatment, and death, reported in four studies. Denosumab was cost-effective in six of the eight included studies. Methodological quality was high, with all studies meeting ≥80% of the Drummond criteria.
CONCLUSIONS: The majority of the included studies support denosumab as a more cost-effective treatment option for bone metastases in solid & non-solid tumours compared to other bone-targeting agents.