Discussing the poster at the ASCO meeting, Dr. Thomas J. Smith of the Massey Cancer Center at Virginia Commonwealth University, Richmond, said it "raises some significant concern about money-driven value in metastatic breast cancer treatment."
Dr. Smith said that the study raises questions about physicians’ ability to negotiate prices, and how to use these data in making decisions. "I can tell you that at most hospitals, most P&T [pharmacy and therapeutics] committees have wrestled exactly with this, ... and where does this fit in pathway-driven managed care, where you get a fixed amount to take care of these patients?" he said.
That the analysis was funded by the maker of zoledronic acid also was a concern. "So I would wait to draw conclusions until this has been through peer review," Dr. Smith said.
The prostate cancer study found that denosumab marginally improved quality of life (+0.0043 QALYs) relative to zoledronic acid, and reduced costs of SREs by $1,924 based on a calculation that these would cost $7,604 with denosumab vs. $9,528 with zoledronic acid over 27 months of treatment. To achieve those benefits, the patient would have to invest more than $7,313 in additional drug costs with denosumab, and thus incur a net cost of $5,390 over 27 months, according to the study.
Novartis, the maker of zoledronic acid, sponsored both studies. Mr. Carter and Dr. Snedecor disclosed consultant or advisory roles with Novartis. One of their coauthors was a Novartis employee with stock ownership. Mr. Botteman disclosed consultant or advisory roles with Pharmerit. Dr. Smith disclosed research funding from the American Cancer Society and the National Cancer Institute.