Clinical Pharmacy Services Publications

Zoledronic Acid vs Pamidronate for the Prevention of Hypercalcemia of Malignancy or Bone Metastases in Hospital Outpatients: Time Analysis and Economic Implications.

David C. Gammon, University of Massachusetts Medical School
Hoang T. Le


Zoledronic acid, a third-generation bisphosphonate, is one of the most potent agents in its class available for treating patients with hypercalcemia of malignancy (HCM) and osteolytic metastasis. Pamidronate and zoledronic acid have both shown safety and efficacy beyond 24 months of use and both decrease the risk of bone complications in patients with other cancers and multiple myeloma. Based on the equivalence of these two products, our cancer center evaluated the financial impact and potential reductions in administration time from the shortened zoledronic acid infusion of 15 minutes compared with that of 2 hours for pamidronate. Fifty-three oncology/hematology outpatients, including 28 patients who had previously received pamidronate, received 305 total doses of zoledronic acid 4 mg given as an IV infusion in an 8-month period. Although the acquisition costs of zoledronic acid 4 mg are greater than that for pamidronate 90 mg, we retrospectively identified equivalent reimbursements per dose, as a percentage of cost. The conservation of time and resources for the administration of zoledronic acid offered an opportunity to treat more patients with the existing nursing staff and the opportunity to improve the quality of life for our patients by shortening their time in the clinic.