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Relative Effectiveness of Osteoporos...

Poon, Yeesha.

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Relative Effectiveness of Osteoporosis Treatments to Reduce Hip Fractures in Patients with Prostate Cancer on Continuous Androgen Deprivation Therapy: Systematic Review, Network Meta-Analysis and Cost-Effectiveness Analysis.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Relative Effectiveness of Osteoporosis Treatments to Reduce Hip Fractures in Patients with Prostate Cancer on Continuous Androgen Deprivation Therapy: Systematic Review, Network Meta-Analysis and Cost-Effectiveness Analysis./
作者:	Poon, Yeesha.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2018,
面頁冊數:	120 p.
附註:	Source: Dissertations Abstracts International, Volume: 80-06, Section: A.
Contained By:	Dissertations Abstracts International80-06A.
標題:	Economics. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=10936590
ISBN:	9780438683907

Relative Effectiveness of Osteoporosis Treatments to Reduce Hip Fractures in Patients with Prostate Cancer on Continuous Androgen Deprivation Therapy: Systematic Review, Network Meta-Analysis and Cost-Effectiveness Analysis.
Poon, Yeesha.

Relative Effectiveness of Osteoporosis Treatments to Reduce Hip Fractures in Patients with Prostate Cancer on Continuous Androgen Deprivation Therapy: Systematic Review, Network Meta-Analysis and Cost-Effectiveness Analysis. - Ann Arbor : ProQuest Dissertations & Theses, 2018 - 120 p.

Source: Dissertations Abstracts International, Volume: 80-06, Section: A.

Thesis (Ph.D.)--University of Toronto (Canada), 2018.

This item is not available from ProQuest Dissertations & Theses.

Background: Androgen deprivation therapy (ADT) is widely used in men with advanced prostate cancer, and can lead to loss of bone mineral density (BMD) and fractures. Osteoporosis treatments are effective in improving BMD, and reducing risk of hip fractures. Given the potential benefits, risks, and widely varying costs of osteoporosis treatments in our population, we assessed the effects and cost-effectiveness of treatments. Methods: A systematic review and a network meta-analysis were conducted using randomized controlled trials (RCT) that evaluated bisphosphonates, denosumab, toremifene, and raloxifene in patients with non-metastatic prostate cancer on ADT. Outcomes included percentage change in BMD from placebo at different bone sites and incidence rates of any fractures. A cost-utility model was developed using a state transition model simulating the progression of prostate cancer, the incidence of hip fractures and an adverse event from osteoporosis treatments. The risk of fracture was conditional on BMD changes, which were modeled as the means of determining the effect of treatment on health and cost outcomes. The outcomes were predicted hip fracture incidence, quality-adjusted life years (QALYs), expected costs, and incremental cost-effectiveness ratios. Results: Thirteen RCTs were included for analysis. The largest BMD improvement compared to placebo at 12-month at femoral neck site was risedronate 6.77% (95% CrI:-6.87-20.27%). Two studies reported fractures; toremifene and denosumab studies reported improved incidence of new vertebral fracture outcome vs placebo (2.5% vs 4.9%;p<0.05 and 1.0% vs 3.3%;p=0.004, respectively) at 2-year timepoint. Alendronate was found to be the preferred strategy. The cost/QALY gained was $30,000 (95% CI:$28,241-$32,574) compared to placebo. Other treatments were dominated, except for zoledronic acid. Conclusions: The analysis showed that oral bisphosphonates are cost-effective options. Guidelines could consider oral bisphosphonates for patients with prostate cancer on ADT without other risk factors, and a subpopulation for newer and more expensive treatments such as denosumab.

ISBN: 9780438683907Subjects--Topical Terms:

517137
Economics.
Subjects--Index Terms:

Androgen deprivation therapy

Relative Effectiveness of Osteoporosis Treatments to Reduce Hip Fractures in Patients with Prostate Cancer on Continuous Androgen Deprivation Therapy: Systematic Review, Network Meta-Analysis and Cost-Effectiveness Analysis.
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520 $a Background: Androgen deprivation therapy (ADT) is widely used in men with advanced prostate cancer, and can lead to loss of bone mineral density (BMD) and fractures. Osteoporosis treatments are effective in improving BMD, and reducing risk of hip fractures. Given the potential benefits, risks, and widely varying costs of osteoporosis treatments in our population, we assessed the effects and cost-effectiveness of treatments. Methods: A systematic review and a network meta-analysis were conducted using randomized controlled trials (RCT) that evaluated bisphosphonates, denosumab, toremifene, and raloxifene in patients with non-metastatic prostate cancer on ADT. Outcomes included percentage change in BMD from placebo at different bone sites and incidence rates of any fractures. A cost-utility model was developed using a state transition model simulating the progression of prostate cancer, the incidence of hip fractures and an adverse event from osteoporosis treatments. The risk of fracture was conditional on BMD changes, which were modeled as the means of determining the effect of treatment on health and cost outcomes. The outcomes were predicted hip fracture incidence, quality-adjusted life years (QALYs), expected costs, and incremental cost-effectiveness ratios. Results: Thirteen RCTs were included for analysis. The largest BMD improvement compared to placebo at 12-month at femoral neck site was risedronate 6.77% (95% CrI:-6.87-20.27%). Two studies reported fractures; toremifene and denosumab studies reported improved incidence of new vertebral fracture outcome vs placebo (2.5% vs 4.9%;p<0.05 and 1.0% vs 3.3%;p=0.004, respectively) at 2-year timepoint. Alendronate was found to be the preferred strategy. The cost/QALY gained was $30,000 (95% CI:$28,241-$32,574) compared to placebo. Other treatments were dominated, except for zoledronic acid. Conclusions: The analysis showed that oral bisphosphonates are cost-effective options. Guidelines could consider oral bisphosphonates for patients with prostate cancer on ADT without other risk factors, and a subpopulation for newer and more expensive treatments such as denosumab.
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