The ProtecT randomised trial cost-effectiveness analysis comparing active monitoring, surgery, or radiotherapy for prostate cancer

There is limited evidence relating to the cost-effectiveness of treatments for localised prostate cancer. The cost-effectiveness of active monitoring, surgery, and radiotherapy was evaluated within the Prostate Testing for Cancer and Treatment (ProtecT) randomised controlled trial from a UK NHS pers...

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Bibliographic Details
Published in:British journal of cancer 2020-09, Vol.123 (7), p.1063-1070
Main Authors: Noble, Sian M, Garfield, Kirsty, Lane, J Athene, Metcalfe, Chris, Davis, Michael, Walsh, Eleanor I, Martin, Richard M, Turner, Emma L, Peters, Tim J, Thorn, Joanna C, Mason, Malcolm, Bollina, Prasad, Catto, James W F, Doherty, Alan, Gnanapragasam, Vincent, Hughes, Owen, Kockelbergh, Roger, Kynaston, Howard, Paul, Alan, Paez, Edgar, Rosario, Derek J, Rowe, Edward, Oxley, Jon, Staffurth, John, Neal, David E, Hamdy, Freddie C, Donovan, Jenny L
Format: Article
Language:English
Subjects:
Adult
Aged
Clinical trials
Cost analysis
Cost-Benefit Analysis
Health Care Costs
Humans
Male
Middle Aged
Prostate cancer
Prostatic Neoplasms - therapy
Quality-Adjusted Life Years
Radiation therapy
Risk groups
Sensitivity analysis
Surgery
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Summary:There is limited evidence relating to the cost-effectiveness of treatments for localised prostate cancer. The cost-effectiveness of active monitoring, surgery, and radiotherapy was evaluated within the Prostate Testing for Cancer and Treatment (ProtecT) randomised controlled trial from a UK NHS perspective at 10 years' median follow-up. Prostate cancer resource-use collected from hospital records and trial participants was valued using UK reference-costs. QALYs (quality-adjusted-life-years) were calculated from patient-reported EQ-5D-3L measurements. Adjusted mean costs, QALYs, and incremental cost-effectiveness ratios were calculated; cost-effectiveness acceptability curves and sensitivity analyses addressed uncertainty; subgroup analyses considered age and disease-risk. Adjusted mean QALYs were similar between groups: 6.89 (active monitoring), 7.09 (radiotherapy), and 6.91 (surgery). Active monitoring had lower adjusted mean costs (£5913) than radiotherapy (£7361) and surgery (£7519). Radiotherapy was the most likely (58% probability) cost-effective option at the UK NICE willingness-to-pay threshold (£20,000 per QALY). Subgroup analyses confirmed radiotherapy was cost-effective for older men and intermediate/high-risk disease groups; active monitoring was more likely to be the cost-effective option for younger men and low-risk groups. Longer follow-up and modelling are required to determine the most cost-effective treatment for localised prostate cancer over a man's lifetime. Current Controlled Trials number, ISRCTN20141297: http://isrctn.org (14/10/2002); ClinicalTrials.gov number, NCT02044172: http://www.clinicaltrials.gov (23/01/2014).
ISSN:0007-0920
1532-1827
DOI:10.1038/s41416-020-0978-4