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 W F 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 E Neal, Freddie C Hamdy, Jenny L Donovan, 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 W F 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 E Neal, Freddie C Hamdy, Jenny L Donovan

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).

Conflict of interest statement

S.M.N., K.G., J.A.L., C.M., M.D., E.I.W., T.J.P., F.C.H., D.E.N. and J.L.D. had financial support from NIHR HTA and J.C.T., R.M.M. and E.L.T. from CRUK for the submitted work; M.M. reports personal fees from Janssen Endocyte and Clovis’ and scientific advisor to Ellipsis Pharma and to Oncotherics, outside the submitted work. All other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Line charts displaying for each annual follow-up time point, by allocation arm (Active monitoring, Radiotherapy, Radical prostatectomy) the (a) mean adjusted annual costs and (b) mean adjusted annual QALYs (see Supplementary Tables 3 and 4 for sample sizes).
Fig. 2
Fig. 2
Cost-effectiveness acceptability curve displaying the probability of each treatment (Active monitoring, Radiotherapy, Radical prostatectomy) being the cost-effective option at different willingness-to-pay thresholds.

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Source: PubMed

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