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Evidence shows little difference in how effectively<jats:styled-content style=\"fixed-case\">SFX<\/jats:styled-content>and<jats:styled-content style=\"fixed-case\">MFX<\/jats:styled-content>reduce pain. However,<jats:styled-content style=\"fixed-case\">SFX<\/jats:styled-content>is associated with higher retreatment and (in one meta\u2010analysis) pathological fracture rates.<jats:styled-content style=\"fixed-case\">MFX<\/jats:styled-content>is, however, more time\u2010consuming and expensive. We estimated the cost\u2010effectiveness of<jats:styled-content style=\"fixed-case\">SFX<\/jats:styled-content>versus<jats:styled-content style=\"fixed-case\">MFX<\/jats:styled-content>for metastatic bone pain in breast, prostate and lung cancer in New Zealand.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We constructed a Markov microsimulation model to estimate health gain (in quality\u2010adjusted life\u2010years or<jats:styled-content style=\"fixed-case\">QALY<\/jats:styled-content>s), health system costs (in real 2011<jats:styled-content style=\"fixed-case\">NZ<\/jats:styled-content>dollars) and cost\u2010effectiveness. The model was populated using effect estimates from randomized controlled trials and other studies, and New Zealand cancer and cost data. Disability weights from the 2010 Global Burden of Disease study were used in estimating<jats:styled-content style=\"fixed-case\">QALY<\/jats:styled-content>s.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Across all three cancers,<jats:styled-content style=\"fixed-case\">QALY<\/jats:styled-content>gains were similar for<jats:styled-content style=\"fixed-case\">SFX<\/jats:styled-content>compared to<jats:styled-content style=\"fixed-case\">MFX<\/jats:styled-content>, and per patient costs were less for<jats:styled-content style=\"fixed-case\">SFX<\/jats:styled-content>than<jats:styled-content style=\"fixed-case\">MFX<\/jats:styled-content>, with a difference of<jats:styled-content style=\"fixed-case\">NZ<\/jats:styled-content>$1469 (95% uncertainty interval $1112 to $1886) for lung cancer, $1316 ($810 to $1854) for prostate cancer and $1344 ($855 to $1846) for breast cancer. Accordingly, from a cost\u2010effectiveness perspective,<jats:styled-content style=\"fixed-case\">SFX<\/jats:styled-content>was the preferable treatment option. Various sensitivity analyses did not overturn the clear preference for<jats:styled-content style=\"fixed-case\">SFX<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>For all three cancers,<jats:styled-content style=\"fixed-case\">SFX<\/jats:styled-content>was clearly more cost\u2010effective than<jats:styled-content style=\"fixed-case\">MFX<\/jats:styled-content>. This adds to the case for desisting from offering<jats:styled-content style=\"fixed-case\">MFX<\/jats:styled-content>to patients with metastatic bone pain, from a cost\u2010effectiveness angle.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1754-9485.12467","type":"journal-article","created":{"date-parts":[[2016,5,13]],"date-time":"2016-05-13T05:46:54Z","timestamp":1463118414000},"page":"650-660","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Economic evaluation of single\u2010fraction versus multiple\u2010fraction palliative radiotherapy for painful bone metastases in breast, lung and prostate cancer"],"prefix":"10.1111","volume":"60","author":[{"given":"Lucie","family":"Collinson","sequence":"first","affiliation":[{"name":"Burden of Disease, Epidemiology, Equity and Cost Effectiveness Programme (BODE<sup>3<\/sup>) Department of Public Health University of Otago Wellington New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgi","family":"Kvizhinadze","sequence":"additional","affiliation":[{"name":"Burden of Disease, Epidemiology, Equity and Cost Effectiveness Programme (BODE<sup>3<\/sup>) Department of Public Health University of Otago Wellington New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisha","family":"Nair","sequence":"additional","affiliation":[{"name":"Burden of Disease, Epidemiology, Equity and Cost Effectiveness Programme (BODE<sup>3<\/sup>) Department of Public Health University of Otago Wellington New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"McLeod","sequence":"additional","affiliation":[{"name":"Burden of Disease, Epidemiology, Equity and Cost Effectiveness Programme (BODE<sup>3<\/sup>) Department of Public Health University of Otago Wellington New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Blakely","sequence":"additional","affiliation":[{"name":"Burden of Disease, Epidemiology, Equity and Cost Effectiveness Programme (BODE<sup>3<\/sup>) Department of Public Health University of Otago Wellington New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,5,13]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2010.227"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2354.2009.01135.x"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2009.0076"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19971015)80:8 <1588::AID-CNCR9>3.0.CO;2-G"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(92)90565-Y"},{"key":"e_1_2_6_7_1","first-page":"Cd004721","article-title":"Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy \u2010 a systematic review of the randomised trials","volume":"2","author":"Sze WM","year":"2004","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2007.11.062"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2011.12.095"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2008.12.084"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(02)04147-0"},{"key":"e_1_2_6_12_1","first-page":"CD001793","article-title":"Radiotherapy for the palliation of painful bone metastases","author":"McQuay HJ","year":"2000","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2011.11.004"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.09.5281"},{"key":"e_1_2_6_15_1","unstructured":"2007 International Atomic Energy Agency Vienna Austria IAEA NM Section Criteria for palliation of bone metastases \u2013 clinical applications 10"},{"key":"e_1_2_6_16_1","unstructured":"2010 Cancer Council Australia and Australian Cancer Network Sydney Cancer Council Australia and Australian Cancer Network Party ACNMoMPCW Clinical practice guidelines for the management of locally advanced and metastatic prostate cancer 61"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-006-0161-3"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2004.05.053"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/COC.0b013e31818da9f7"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/95.3.222"},{"key":"e_1_2_6_21_1","unstructured":"FosterR BlakelyT WilsonN ODeaD.Protocol for direct costing of health sector interventions for economic modelling (including event pathways). 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