Bone-Modifying Agent Utilization: An Analysis in Patients With Metastatic Cancer and Bone Involvement at an NCI-Designated Cancer Center

We assessed bone-modifying agent (BMA) utilization and cost in patients with metastatic cancer and bone involvement at a National Cancer Institute–designated cancer center. We performed a retrospective review of BMA (zoledronic acid [ZA] or denosumab [DB]) utilization for fiscal years 2015 to 2020 (N = 1,421 patients; 14,545 administrations); a 60-day cutoff defined treatment interval (Q1 vs Q3). Wholesale acquisition and administration costs were esti­mated from the Centers for Medicare & Medicaid Services–allowed charges. We calculated total costs and projected potential savings for switching from Q1 to Q3 ZA administration. There were 8,247 ZA administrations (1,003 patients) and 6,308 DB administrations (536 patients), and an increase in the proportion of Q3 ZA administrations in patients with breast cancer or multiple myeloma. Total costs on BMA utilization were estimated as $14.3 million, 90% attributable to DB. The projected savings for switching from Q1 to Q3 ZA administration among all tumor types was $1.0 million. Awareness of BMA prescribing patterns provides the opportunity to create institutional pathways, align practice with best avail­able evidence, and realize substantial savings.