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

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Abstract
The economic impact of using prophylactic clodronate as an adjunct to chemotherapy in the management of multiple myeloma for the first 4 years following diagnosis was established from the perspective of the National Health Service (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 management and managing severe hypercalcaemia, vertebral and non‐vertebral fractures. Managing patients with prophylactic clodronate cost the NHS a mean £22 934 per patient; comprising £16 697 for standard management, £4862 for clodronate therapy and £1376 for adverse events. Managing patients without prophylactic clodronate cost a mean £19 557 (£16 697 and £2860 for standard management and adverse events respectively). Therefore prophylactic clodronate therapy increased the cost by £3377, or 17% per patient. Hospitalization accounted for 32% of the total cost, whereas chemotherapy accounted for 5%. The results were robust to sensitivity analyses (range £2605–£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.