Cost-effectiveness of zoledronic acid and strontium-89 as bone protecting treatments in addition to chemotherapy in patients with metastatic castrate-refractory prostate cancer: results from the TRAPEZE trial (ISRCTN 12808747)

Research output: Contribution to journalArticlepeer-review


  • Ann Pope
  • Darren Barton
  • Stuart Collins
  • Adam Daunton
  • Duncan McLaren
  • Joe M O'Sullivan
  • Chris Parker
  • Emilio Porfiri
  • John Staffurth
  • Andrew Stanley
  • James Wylie
  • Sharon Beesley
  • Alison Birtle
  • Janet E Brown
  • Prabir Chakraborti
  • Syed A Hussain
  • J Martin Russell
  • Lucinda J Billingham
  • Nicholas D James

External organisations

  • Health Economics Unit, School of Health & Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
  • Posthumously listed (previously CRCTU Birmingham), Birmingham, UK.
  • Western General Hospital, Edinburgh, UK.
  • Department of Medical Genetics, Belfast City Hospital, Belfast, BT9 7AB
  • Royal Marsden Hospital, London
  • Cardiff University
  • Birmingham City Hospital
  • Kent Oncology Centre, Maidstone
  • Rosemere Cancer Centre, Royal Preston Hospital
  • St James' University Hospital, Leeds, UK.
  • Royal Derby Hospital
  • University of Liverpool
  • Beatson West Scotland Cancer Centre, Glasgow G12 0YN, UK.
  • University Hospitals Birmingham NHS Foundation Trust
  • The Christie Hospital, Manchester M20 4BX, UK.


OBJECTIVE: To evaluate the cost-effectiveness of adding zoledronic acid or strontium-89 to standard docetaxel chemotherapy for patients with castrate-refractory prostate cancer (CRPC).

PATIENTS AND METHODS: Data on resource use and quality of life for 707 patients collected prospectively in the TRAPEZE 2 × 2 factorial randomised trial (ISRCTN 12808747) were used to assess the cost-effectiveness of i) zoledronic acid versus no zoledronic acid (ZA vs. no ZA), and ii) strontium-89 versus no strontium-89 (Sr89 vs. no Sr89). Costs were estimated from the perspective of the National Health Service in the UK and included expenditures for trial treatments, concomitant medications, and use of related hospital and primary care services. Quality-adjusted life-years (QALYs) were calculated according to patients' responses to the generic EuroQol EQ-5D-3L instrument, which evaluates health status. Results are expressed as incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves.

RESULTS: The per-patient cost for ZA was £12 667, £251 higher than the equivalent cost in the no ZA group. Patients in the ZA group had on average 0.03 QALYs more than their counterparts in no ZA group. The ICER for this comparison was £8 005. Sr89 was associated with a cost of £13 230, £1365 higher than no Sr89, and a gain of 0.08 QALYs compared to no Sr89. The ICER for Sr89 was £16 884. The probabilities of ZA and Sr89 being cost-effective were 0.64 and 0.60, respectively.

CONCLUSIONS: The addition of bone-targeting treatments to standard chemotherapy led to a small improvement in QALYs for a modest increase in cost (or cost-savings). ZA and Sr89 resulted in ICERs below conventional willingness-to-pay per QALY thresholds, suggesting that their addition to chemotherapy may represent a cost-effective use of resources.


Original languageEnglish
Pages (from-to)522-529
Number of pages8
JournalBJU international
Issue number4
Early online date3 Jun 2016
Publication statusPublished - Apr 2017


  • castrate-refractory prostate cancer, cost-effectiveness analysis, quality of ilife, bone protecting treatments, zoledronic acid, strontium-89