Economic analysis of terminal care for patients with malignant osteolytic bone disease and pain treated with pamidronate

The goals of this study were the assessment (1) of all costs of terminal ca re of patients with osteolytic bone disease and pain and (2) of the economi c consequences of the pamidronate treatment as observed in a prospective cl inical trial on the effectiveness of pamidronate. A total of 70 patients we re recruited, who were all suffering from advanced tumour diseases (60% bre ast cancer, 21% multiple myeloma, and 19% other tumours). In a single-insti tution study the patients were randomly assigned to receive, in a double-bl inded setting, pamidronate 60 mg i.v. or 90 mg i.v. every 3 weeks for a max imum of six cycles. Perception of pain intensity was recorded by self-asses sment, using a linear analogue scale. Follow-up lasted 6 months after treat ment. All elements of direct costs of in-patient and out-patient care were recorded in cooperation with the hospital administration and the health ins urance companies [Krankenkassen]. Average monthly direct costs amounted to ECU 1,290 (+/-410) and 1,050 (+/-430) during the treat ment phase and follo w-up, respectively. Average in-patient costs were about three times the out -patient costs. Significantly higher costs (by a factor of 2) were observed for terminal care in hospital (last 3 months before death) than for contin ued care (of patients surviving the study period). The treatment with pamid ronate reduced pain significantly but did not add noticeably to the costs. The study showed that it is practicable and quite efficient to combine a ph armaco-economic evaluation with a clinical trial, although it may be diffic ult (depending on the setting and availability of information) to assess tr ue costs, i.e. total resource usage.