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  Paez; Derek J.  Rosario; Edward Rowe; Jon  Oxley; John  Staffurth; David Neal; Freddie C.  Hamdy; Jenny L Donovan

doi:10.1038/s41416-020-0978-4

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 journal › Article (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 language	English
Number of pages	8
Journal	British Journal of Cancer
Early online date	16 Jul 2020
DOIs	https://doi.org/10.1038/s41416-020-0978-4
Publication status	E-pub ahead of print - 16 Jul 2020

Structured keywords

ICEP
BRTC
BTC (Bristol Trials Centre)
HEHP@Bristol

Keywords

Health care economics
Prostate cancer

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Dr Sian M Noble
- S.M.Noblebristol.acuk
- Bristol Medical School (PHS) - Senior Lecturer in Health Economics
- Bristol Population Health Science Institute
- Cancer
Person: Academic , Member

Cite this

Noble, S. M., Garfield, K., Lane, J. A., Metcalfe, C., Davis, M., Walsh, E. I., Martin, R. M., Turner, E. L., Peters, T. J., Thorn, J. C., Mason, M., Bollina, P., Catto, J., Doherty, A., Gnanapragasam, V., Hughes, O., Kockelbergh, R., Kynaston, H., Paul, A., ... Donovan , J. L. (2020). The ProtecT randomised trial cost-effectiveness analysis comparing Active Monitoring, Surgery, or Radiotherapy for Prostate Cancer. British Journal of Cancer. Advance online publication. https://doi.org/10.1038/s41416-020-0978-4

@article{2f1751336d104a1391b23bc9bc4ed29d,

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

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{\textquoteright} 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{\textquoteright}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)",

keywords = "Health care economics, Prostate cancer",

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

year = "2020",

month = jul,

day = "16",

doi = "10.1038/s41416-020-0978-4",

language = "English",

journal = "British Journal of Cancer",

issn = "0007-0920",

publisher = "Springer Nature",

}

Noble, SM , Garfield, K , Lane, JA , Metcalfe, C, Davis, M, Walsh, EI , Martin, RM , Turner, EL , Peters, TJ , Thorn, JC, Mason, M, Bollina, P, Catto, J, Doherty, A, Gnanapragasam, V, Hughes, O, Kockelbergh, R, Kynaston, H, Paul, A, Paez, E, Rosario, DJ, Rowe, E, Oxley, J, Staffurth, J, Neal, D, Hamdy, FC & Donovan , JL 2020, 'The ProtecT randomised trial cost-effectiveness analysis comparing Active Monitoring, Surgery, or Radiotherapy for Prostate Cancer', British Journal of Cancer. https://doi.org/10.1038/s41416-020-0978-4

TY - JOUR

T1 - The ProtecT randomised trial cost-effectiveness analysis comparing Active Monitoring, Surgery, or Radiotherapy for Prostate Cancer

AU - Noble, Sian M

AU - Garfield, Kirsty

AU - Lane, J. Athene

AU - Metcalfe, Chris

AU - Davis, Michael

AU - Walsh, Eleanor I

AU - Martin, Richard M

AU - Turner, Emma L

AU - Peters, Tim J

AU - Thorn, Joanna C

AU - Mason, Malcolm

AU - Bollina, Prasad

AU - Catto, James

AU - Doherty, Alan

AU - Gnanapragasam, Vincent

AU - Hughes, Owen

AU - Kockelbergh, Roger

AU - Kynaston, Howard

AU - Paul, Alan

AU - Paez, Edgar

AU - Rosario, Derek J.

AU - Rowe, Edward

AU - Oxley, Jon

AU - Staffurth, John

AU - Neal, David

AU - Hamdy, Freddie C.

AU - Donovan , Jenny L

PY - 2020/7/16

Y1 - 2020/7/16

N2 - 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)

AB - 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)

KW - Health care economics

KW - Prostate cancer

U2 - 10.1038/s41416-020-0978-4

DO - 10.1038/s41416-020-0978-4

M3 - Article (Academic Journal)

C2 - 32669672

SN - 0007-0920

JO - British Journal of Cancer

JF - British Journal of Cancer

ER -

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

Abstract

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