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Original article
Cost per patient and potential budget implications of denosumab compared with zoledronic acid in adults with bone metastases from solid tumours who are at risk of skeletal-related events: an analysis for Austria, Sweden and Switzerland
  1. Mickael Lothgren1,
  2. Erna Ribnicsek2,
  3. Louise Schmidt3,
  4. Wolfgang Habacher3,
  5. Jonas Lundkvist4,
  6. Alena M Pfeil5,
  7. Irina Biteeva6,
  8. Polina Vrouchou1,
  9. Andrea Bracco1
  1. 1International Health Economics and Reimbursement, Amgen (Europe) GmbH, Zug, Switzerland
  2. 2Market Access, Amgen (Austria) GmbH, Vienna, Austria
  3. 3HEALTH-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
  4. 4Health Economics and Reimbursement, Amgen AB, Solna, Sweden
  5. 5Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
  6. 6Health Economics and Reimbursement, Amgen Switzerland AG, Zug, Switzerland.
  1. Correspondence to Dr M Lothgren, International Health Economics and Reimbursement, Amgen (Europe) GmbH, Dammstrasse 23, Zug 6301, Switzerland; mickaell{at}


Objectives To assess cost implications per patient, per year, and to predict the potential annual budget impact when patients with bone metastases secondary to solid tumours at risk of skeletal-related events (SREs) transition from zoledronic acid (ZA; 4 mg every 3–4 weeks) to denosumab (120 mg every 4 weeks) in Austria, Sweden and Switzerland.

Methods Country specific costs for medication and administration, patient management and SREs (defined as pathologic fracture, radiation to bone, surgery to bone and spinal cord compression) were assessed over a 1-year time horizon. Drug administration and patient management costs were taken from available public sources. SRE costs were based on local unit costs applied to country specific healthcare resources obtained from a multinational retrospective chart review study. Due to lack of real world data for the included countries, SRE rates were derived from phase III clinical trials in patients with advanced cancer and bone metastases. These trials demonstrated that denosumab was superior to ZA in the reduction of SREs.

Results Estimated total annual cost savings for each patient transitioned from ZA to denosumab varied by country and cancer type, ranging from €1583 to €2375 in Austria, from €1980 to €2319 in Sweden (9.1 SEK/€) and from €3408 to €3857 in Switzerland (1.2 CHF/€). Cost savings were mainly driven by the lower SRE related costs and lower administration costs of denosumab compared with ZA.

Conclusions Denosumab offers superior efficacy compared with ZA in patients with solid tumours and bone metastases. Cost savings are predicted in the Austrian, Swedish and Swiss healthcare systems following treatment transition from ZA to denosumab.

  • budget impact
  • bone metastases
  • skeletal-related events
  • denosumab
  • zoledronic acid

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