Annual zoledronic acid infusion lowers risk of fracture, death
Challenges to implementation: $1200 per dose
The FDA approved Reclast (zoledronic acid 5 mg) as a once-yearly treatment for postmenopausal osteoporosis and Paget’s disease in August 2007. (Zometa is the brand name for zoledronic acid 4 mg that is indicated for multiple myeloma, bone metastasis, and hypercalcemia of malignancy.) Medicare and most insurance plans will reimburse Reclast infusion for these FDA-approved indications when billed by a provider using a CPT code. It is administered intravenously over 15-minutes and there are no risks beyond those associated with local infiltration.
The greatest barrier to implementing this practice for solo physicians or small group practices will likely be the up front expense of buying the drug; one dose is approximately $1200. Patients can be referred to larger practices or hospitals with the capital to have zoledronic acid on hand and the capability of providing the infusion.
The cost is comparable to the annual cost of oral bisphosphonates and less than the cost of the other IV bisphosphonate (ibandronate), which is administered every 3 months ( TABLE 2 ).
TABLE 2
Bisphosphonates for osteoporosis: Routes, dosage, and cost
| GENERIC NAME | BRAND NAME | ROUTE OF ADMINISTRATION | DOSE AND FREQUENCY | APPROXIMATE ANNUAL COST |
|---|---|---|---|---|
| Alendronate | Fosamax | Oral | 10 mg/d or 70 mg/week | $960–$1120 |
| Ibandronate | Boniva | Oral or IV | 2.5 mg/d, 150 mg monthly (PO) or 3 mg IV every 3 months | $1140–$1200 PO, $1980 IV |
| Risedronate | Actonel | Oral | 5 mg/d or 35 mg/week | $1000–$1100 |
| Zoledronic acid | Reclast | IV | 5 mg once a year | $1200 |
PURLS methodology
This study was selected and evaluated using FPIN’s Priority Updates from the Research Literature Surveillance System methodology. The criteria and findings leading to the selection of this study as a PURL can be accessed at here.
