The ProtecT randomised trial cost-effectiveness analysis comparing Active Monitoring, Surgery, or Radiotherapy for Prostate Cancer

Sian M Noble*, Kirsty Garfield, J. Athene Lane, Chris Metcalfe, Michael Davis, Eleanor I Walsh, Richard M Martin, Emma L Turner, Tim J Peters, Joanna C Thorn, Malcolm Mason, Prasad Bollina, James Catto, Alan Doherty, Vincent Gnanapragasam, Owen Hughes, Roger Kockelbergh, Howard Kynaston, Alan Paul, Edgar PaezDerek J. Rosario, Edward Rowe, Jon Oxley, John Staffurth, David Neal, Freddie C. Hamdy, Jenny L Donovan

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Background
There is limited evidence relating to the cost-effectiveness of treatments for localised prostate cancer.

Methods
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.

Results
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.

Conclusions
Longer follow-up and modelling are required to determine the most cost-effective treatment for localised prostate cancer over a man’s lifetime.

Trial Registration:
Current Controlled Trials number, ISRCTN20141297: http://isrctn.org (14/10/2002)
ClinicalTrials.gov number, NCT02044172:http://www.clinicaltrials.gov (23/01/2014)
Original languageEnglish
Number of pages8
JournalBritish Journal of Cancer
Early online date16 Jul 2020
DOIs
Publication statusE-pub ahead of print - 16 Jul 2020

Structured keywords

  • ICEP
  • BRTC
  • BTC (Bristol Trials Centre)

Keywords

  • Health care economics
  • Prostate cancer

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