Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial

Madeleine Cochrane; Marcus J Drake; Jo Worthington; Jessica Frost; Nikki Cotterill; Mandy Fader; Lucy McGeagh; Hashim Hashim; Athene Lane; Margaret Macaulay; Stephanie MacNeill; Jonathan Rees; Matthew J Ridd; Luke A Robles; Emily Sanderson; Gordon Taylor; Jodi Taylor; Sian Noble

doi:10.1136/bmjopen-2023-075704

Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial

Madeleine Cochrane^*, Marcus J Drake, Jo Worthington, Jessica Frost, Nikki Cotterill, Mandy Fader, Lucy McGeagh, Hashim Hashim, Athene Lane, Margaret Macaulay, Stephanie MacNeill, Jonathan Rees, Matthew J Ridd, Luke A Robles, Emily Sanderson, Gordon Taylor, Jodi Taylor, Sian Noble

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

1 Citation (Scopus)

46 Downloads (Pure)

Abstract

OBJECTIVES: To estimate the cost-effectiveness of a primary care intervention for male lower urinary tract symptoms (LUTS) compared with usual care.

DESIGN: Economic evaluation alongside a cluster randomised controlled trial from a UK National Health Service (NHS) perspective with a 12-month time horizon.

SETTING: Thirty NHS general practice sites in England.

PARTICIPANTS: 1077 men aged 18 or older identified in primary care with bothersome LUTS.

INTERVENTIONS: A standardised and manualised intervention for the treatment of bothersome LUTS was compared with usual care. The intervention group (n=524) received a standardised information booklet with guidance on conservative treatment for LUTS, urinary symptom assessment and follow-up contacts for 12 weeks. The usual care group (n=553) followed local guidelines between general practice sites.

MEASURES: Resource use was obtained from electronic health records, trial staff and participants, and valued using UK reference costs. Quality-adjusted life-years (QALYs) were calculated from the EQ-5D-5L questionnaire. Adjusted mean differences in costs and QALYs and incremental net monetary benefit were estimated.

RESULTS: 866 of 1077 (80.4%) participants had complete data and were included in the base-case analysis. Over the 12-month follow-up period, intervention and usual care arms had similar mean adjusted costs and QALYs. Mean differences were lower in the intervention arm for adjusted costs -£29.99 (95% CI -£109.84 to £22.63) while higher in the intervention arm for adjusted QALYs 0.001 (95% CI -0.011 to 0.014). The incremental net monetary benefit statistic was £48.01 (95% CI -£225.83 to £321.85) at the National Institute for Health and Care Excellence UK threshold of £20 000 per QALY. The cost-effectiveness acceptability curve showed a 63% probability of the intervention arm being cost-effective at this threshold.

CONCLUSIONS: Costs and QALYs were similar between the two arms at 12 months follow-up. This indicates that the intervention can be implemented in general practice at neutral cost.

TRIAL REGISTRATION NUMBER: ISRCTN11669964.

Original language	English
Article number	e075704
Pages (from-to)	e075704
Journal	BMJ Open
Volume	14
DOIs	https://doi.org/10.1136/bmjopen-2023-075704
Publication status	Published - 30 Jan 2024

Bibliographical note

Publisher Copyright:
© 2024 BMJ Publishing Group. All rights reserved.

Research Groups and Themes

HEHP@Bristol
BTC (Bristol Trials Centre)

Keywords

Humans
Male
Cost-Benefit Analysis
State Medicine
England
Primary Health Care
Lower Urinary Tract Symptoms/therapy
Quality-Adjusted Life Years
Quality of Life

Access to Document

10.1136/bmjopen-2023-075704Licence: CC BY

Full-text PDF (final published version) Final published version, 577 KBLicence: CC BY

Handle.net

Persistent link

Cite this

Cochrane, M., Drake, M. J., Worthington, J., Frost, J., Cotterill, N., Fader, M., McGeagh, L., Hashim, H., Lane, A., Macaulay, M., MacNeill, S., Rees, J., Ridd, M. J., Robles, L. A., Sanderson, E., Taylor, G., Taylor, J., & Noble, S. (2024). Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial. BMJ Open, 14, e075704. Article e075704. https://doi.org/10.1136/bmjopen-2023-075704

@article{74094499edbf438d998dbdbf22373f06,

title = "Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial",

abstract = "OBJECTIVES: To estimate the cost-effectiveness of a primary care intervention for male lower urinary tract symptoms (LUTS) compared with usual care.DESIGN: Economic evaluation alongside a cluster randomised controlled trial from a UK National Health Service (NHS) perspective with a 12-month time horizon.SETTING: Thirty NHS general practice sites in England.PARTICIPANTS: 1077 men aged 18 or older identified in primary care with bothersome LUTS.INTERVENTIONS: A standardised and manualised intervention for the treatment of bothersome LUTS was compared with usual care. The intervention group (n=524) received a standardised information booklet with guidance on conservative treatment for LUTS, urinary symptom assessment and follow-up contacts for 12 weeks. The usual care group (n=553) followed local guidelines between general practice sites.MEASURES: Resource use was obtained from electronic health records, trial staff and participants, and valued using UK reference costs. Quality-adjusted life-years (QALYs) were calculated from the EQ-5D-5L questionnaire. Adjusted mean differences in costs and QALYs and incremental net monetary benefit were estimated.RESULTS: 866 of 1077 (80.4%) participants had complete data and were included in the base-case analysis. Over the 12-month follow-up period, intervention and usual care arms had similar mean adjusted costs and QALYs. Mean differences were lower in the intervention arm for adjusted costs -£29.99 (95% CI -£109.84 to £22.63) while higher in the intervention arm for adjusted QALYs 0.001 (95% CI -0.011 to 0.014). The incremental net monetary benefit statistic was £48.01 (95% CI -£225.83 to £321.85) at the National Institute for Health and Care Excellence UK threshold of £20 000 per QALY. The cost-effectiveness acceptability curve showed a 63% probability of the intervention arm being cost-effective at this threshold.CONCLUSIONS: Costs and QALYs were similar between the two arms at 12 months follow-up. This indicates that the intervention can be implemented in general practice at neutral cost.TRIAL REGISTRATION NUMBER: ISRCTN11669964.",

keywords = "Humans, Male, Cost-Benefit Analysis, State Medicine, England, Primary Health Care, Lower Urinary Tract Symptoms/therapy, Quality-Adjusted Life Years, Quality of Life",

author = "Madeleine Cochrane and Drake, {Marcus J} and Jo Worthington and Jessica Frost and Nikki Cotterill and Mandy Fader and Lucy McGeagh and Hashim Hashim and Athene Lane and Margaret Macaulay and Stephanie MacNeill and Jonathan Rees and Ridd, {Matthew J} and Robles, {Luke A} and Emily Sanderson and Gordon Taylor and Jodi Taylor and Sian Noble",

year = "2024",

month = jan,

day = "30",

doi = "10.1136/bmjopen-2023-075704",

language = "English",

volume = "14",

pages = "e075704",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

}

Cochrane, M, Drake, MJ, Worthington, J, Frost, J, Cotterill, N, Fader, M, McGeagh, L, Hashim, H, Lane, A, Macaulay, M, MacNeill, S, Rees, J, Ridd, MJ, Robles, LA, Sanderson, E, Taylor, G, Taylor, J & Noble, S 2024, 'Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial', BMJ Open, vol. 14, e075704, pp. e075704. https://doi.org/10.1136/bmjopen-2023-075704

TY - JOUR

T1 - Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms

T2 - the TRIUMPH cluster randomised controlled trial

AU - Cochrane, Madeleine

AU - Drake, Marcus J

AU - Worthington, Jo

AU - Frost, Jessica

AU - Cotterill, Nikki

AU - Fader, Mandy

AU - McGeagh, Lucy

AU - Hashim, Hashim

AU - Lane, Athene

AU - Macaulay, Margaret

AU - MacNeill, Stephanie

AU - Rees, Jonathan

AU - Ridd, Matthew J

AU - Robles, Luke A

AU - Sanderson, Emily

AU - Taylor, Gordon

AU - Taylor, Jodi

AU - Noble, Sian

PY - 2024/1/30

Y1 - 2024/1/30

N2 - OBJECTIVES: To estimate the cost-effectiveness of a primary care intervention for male lower urinary tract symptoms (LUTS) compared with usual care.DESIGN: Economic evaluation alongside a cluster randomised controlled trial from a UK National Health Service (NHS) perspective with a 12-month time horizon.SETTING: Thirty NHS general practice sites in England.PARTICIPANTS: 1077 men aged 18 or older identified in primary care with bothersome LUTS.INTERVENTIONS: A standardised and manualised intervention for the treatment of bothersome LUTS was compared with usual care. The intervention group (n=524) received a standardised information booklet with guidance on conservative treatment for LUTS, urinary symptom assessment and follow-up contacts for 12 weeks. The usual care group (n=553) followed local guidelines between general practice sites.MEASURES: Resource use was obtained from electronic health records, trial staff and participants, and valued using UK reference costs. Quality-adjusted life-years (QALYs) were calculated from the EQ-5D-5L questionnaire. Adjusted mean differences in costs and QALYs and incremental net monetary benefit were estimated.RESULTS: 866 of 1077 (80.4%) participants had complete data and were included in the base-case analysis. Over the 12-month follow-up period, intervention and usual care arms had similar mean adjusted costs and QALYs. Mean differences were lower in the intervention arm for adjusted costs -£29.99 (95% CI -£109.84 to £22.63) while higher in the intervention arm for adjusted QALYs 0.001 (95% CI -0.011 to 0.014). The incremental net monetary benefit statistic was £48.01 (95% CI -£225.83 to £321.85) at the National Institute for Health and Care Excellence UK threshold of £20 000 per QALY. The cost-effectiveness acceptability curve showed a 63% probability of the intervention arm being cost-effective at this threshold.CONCLUSIONS: Costs and QALYs were similar between the two arms at 12 months follow-up. This indicates that the intervention can be implemented in general practice at neutral cost.TRIAL REGISTRATION NUMBER: ISRCTN11669964.

AB - OBJECTIVES: To estimate the cost-effectiveness of a primary care intervention for male lower urinary tract symptoms (LUTS) compared with usual care.DESIGN: Economic evaluation alongside a cluster randomised controlled trial from a UK National Health Service (NHS) perspective with a 12-month time horizon.SETTING: Thirty NHS general practice sites in England.PARTICIPANTS: 1077 men aged 18 or older identified in primary care with bothersome LUTS.INTERVENTIONS: A standardised and manualised intervention for the treatment of bothersome LUTS was compared with usual care. The intervention group (n=524) received a standardised information booklet with guidance on conservative treatment for LUTS, urinary symptom assessment and follow-up contacts for 12 weeks. The usual care group (n=553) followed local guidelines between general practice sites.MEASURES: Resource use was obtained from electronic health records, trial staff and participants, and valued using UK reference costs. Quality-adjusted life-years (QALYs) were calculated from the EQ-5D-5L questionnaire. Adjusted mean differences in costs and QALYs and incremental net monetary benefit were estimated.RESULTS: 866 of 1077 (80.4%) participants had complete data and were included in the base-case analysis. Over the 12-month follow-up period, intervention and usual care arms had similar mean adjusted costs and QALYs. Mean differences were lower in the intervention arm for adjusted costs -£29.99 (95% CI -£109.84 to £22.63) while higher in the intervention arm for adjusted QALYs 0.001 (95% CI -0.011 to 0.014). The incremental net monetary benefit statistic was £48.01 (95% CI -£225.83 to £321.85) at the National Institute for Health and Care Excellence UK threshold of £20 000 per QALY. The cost-effectiveness acceptability curve showed a 63% probability of the intervention arm being cost-effective at this threshold.CONCLUSIONS: Costs and QALYs were similar between the two arms at 12 months follow-up. This indicates that the intervention can be implemented in general practice at neutral cost.TRIAL REGISTRATION NUMBER: ISRCTN11669964.

KW - Humans

KW - Male

KW - Cost-Benefit Analysis

KW - State Medicine

KW - England

KW - Primary Health Care

KW - Lower Urinary Tract Symptoms/therapy

KW - Quality-Adjusted Life Years

KW - Quality of Life

U2 - 10.1136/bmjopen-2023-075704

DO - 10.1136/bmjopen-2023-075704

M3 - Article (Academic Journal)

C2 - 38296301

SN - 2044-6055

VL - 14

SP - e075704

JO - BMJ Open

JF - BMJ Open

M1 - e075704

ER -

Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial

Abstract

Bibliographical note

Research Groups and Themes

Keywords

Access to Document

Handle.net

Fingerprint

Cite this