Economic impact of using clodronate in the management of patients with multiple myeloma

The economic impact of using prophylactic clodronate as an adjunct to chemo therapy in the management of multiple myeloma for the first 4 years followi ng diagnosis was established from the perspective of the National Health Se rvice (NHS). A state-transition model of the course of multiple myeloma was constructed using the MRC VI myelomatosis trial results and information on patient management obtained retrospectively from clinical trialists. Data were collected on resource use and corresponding costs for standard managem ent and managing severe hypercalcaemia. vertebral and non-vertebral fractur es, Managing patients with prophylactic clodronate cost the NHS a mean poun d 22 934 per patient: comprising pound 16 697 for standard management, poun d 4862 for clodronate therapy and pound 1376 for adverse events. Managing p atients without prophylactic clodronate cost a mean pound 19 557 (pound 16 697 and pound 2860 for standard management and adverse events respectively) . Therefore prophylactic clodronate therapy increased the cost by pound 337 7, or 17% per patient. Hospitalization accounted for 32% of the total cost, whereas chemotherapy accounted for 5%. The results were robust to sensitiv ity analyses (range pound 2605-pound 4150). Further studies are required to assess the impact of prophylactic clodronate on quality of life to enable the clinical benefits and additional cost of this treatment to be compared with other healthcare interventions.