Long-term medication use and follow-up visits are the main drivers affecting costs associated with cancer-related bisphosphonate-associated osteonecrosis of the jaw (BONJ), report researchers in Oral Diseases.
"Strategies to reduce costs associated with BONJ might be directed at prevention, use of cost-effective medical therapies, and when feasible limiting the number of clinical visits," write Mohammed Najm (Al-Mustansiriya University College of Dentistry, Baghdad, Iraq) and colleagues.
About 5% of patients with cancer who are treated with bisphosphonates develop BONJ, a highly painful condition. It is often managed with antibiotics to treat and prevent infection and anticonvulsants to treat neuropathic complications such as dysphagia, and surgery may be required in more advanced cases.
Najm et al conducted a retrospective review of medical records of 92 cancer patients with BONJ treated at Brigham & Women's Hospital (Boston, Massachusetts, USA) between 2002 and 2010. They looked at all direct medical costs associated with BONJ, including office visit fees, laboratory tests, and prescriptions.
The overall median treatment cost was US$ 1667 (€ 1282) per patient. Over 60% of patients had costs over US$ 2000 (€ 1538); the highest cost seen was US$ 25,097 (€ 19,302).
The median cost increased with each advancing stage of BONJ, from a median of US$ 1053 (€ 810) in patients with Stage 0 disease to a median of US$ 4031 (€ 3100) in those with Stage 3 disease. There was no relation between overall costs and clinical outcomes.
Medications accounted for 35% of costs and clinic visits for 31%. Two-thirds of all medication costs were related to prescriptions for amoxicillin/clavulanate potassium. Because of this, the researchers suggest that "alternative and less-expensive antibiotics such as penicillin, amoxicillin, or clindamycin should be considered."
In addition, they recommend that, in addition to cost-prevention strategies, "multicenter analyses should be conducted to account for any center-specific management biases, and prospective studies evaluating various therapies for BONJ should be assessed for relative cost-effectiveness."
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