OBJECTIVES:

To conduct a systematic review of economic studies that compare denosumab and bisphosphonates for the treatment of bone metastases from solid tumors.

METHODS:

Eight databases were searched (Cochrane, JBI, Embase, PubMed, Cinahl with Full Text, Lilacs, Scopus and Web of Science) through related keywords and the controlled vocabulary for each database. Studies were included if they were cost-effectiveness or cost-utility analyses of the treatments of interest, and that aimed at patients with bone metastases secondary to solid tumors. Exclusion occurred when samples comprised patients with other bone diseases. All included studies had their methodological quality assessed, as well as their level of evidence. Data were extracted regarding their setting, methodologic characteristics and cost-effectiveness analyses. For means of comparison, all costs and outcomes were adjusted to 2017 (3% per year); and costs were converted to US Dollars.

RESULTS:

A total of 263 unique studies were retrieved, and only six met the inclusion criteria. All studies were Markov models based on Randomized Clinical Trial data, observational studies, and claims data. They had high methodological quality and level of evidence 1b-3b, and grades of recommendation A and B, respectively. Most found favorable cost-effectiveness for zoledronic acid despite denosumab’s ease of use, shorter time of administration, and lower profile of acute adverse events. Results were sensitive to drug costs, time to first skeletal-related event (SRE), time horizon, and utility.

CONCLUSIONS:

Zoledronic acid was considered cost-effective relative to denosumab in most of the included studies. New economic studies based on real-world data and longer time horizons comparing these therapeutic options are needed.