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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

Publication: British Journal of Cancer, July 2020

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).