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 journalArticle (Academic Journal)peer-review

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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 languageEnglish
Article numbere075704
Pages (from-to)e075704
JournalBMJ Open
Volume14
DOIs
Publication statusPublished - 30 Jan 2024

Bibliographical note

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

Structured keywords

  • 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

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