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)
- BTC (Bristol Trials Centre)
- Health care economics
- Prostate cancer