The ProtecT randomised trial cost-effectiveness analysis comparing active monitoring, surgery, or radiotherapy for prostate cancer


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Authors
Garfield, Kirsty 
Lane, J. Athene 
Metcalfe, Chris 
Davis, Michael 
Abstract

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).

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Keywords
Article, /692/4028/67/589/466, /692/700/3934, article
Journal Title
British Journal of Cancer
Conference Name
Journal ISSN
0007-0920
1532-1827
Volume Title
123
Publisher
Nature Publishing Group UK
Sponsorship
DH | NIHR | Health Technology Assessment Programme (NIHR Health Technology Assessment Programme) (96/20/06, 96/20/99, 96/20/06, 96/20/99, 96/20/06, 96/20/99, 96/20/06, 96/20/99, 96/20/06, 96/20/99, 96/20/06, 96/20/99, 96/20/06, 96/20/99)
Cancer Research UK (CRUK) (C11043/A4286, C18281/A8145, C18281/A11326, C18281/A15064, and C18281/A24432)