There is limited evidence relating to the cost-effectiveness of treatments for localised prostate cancer.
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.
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.
Longer follow-up and modelling are required to determine the most cost-effective treatment for localised prostate cancer over a man's lifetime.
Current Controlled Trials number, ISRCTN20141297: http://isrctn.org (14/10/2002); ClinicalTrials.gov number, NCT02044172: http://www.clinicaltrials.gov (23/01/2014).
British journal of cancer. 2020 Jul 16 [Epub ahead of print]
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
Bristol Medical School, University of Bristol, Bristol, UK. ., Bristol Medical School, University of Bristol, Bristol, UK., The School of Medicine, University of Cardiff, Cardiff, UK., Department of Urology and Surgery, Western General Hospital, Edinburgh, UK., The Academic Urology Unit, University of Sheffield, Sheffield, UK., Department of Urology, Queen Elizabeth Hospital, Birmingham, UK., The Academic Urology Group, University of Cambridge, Cambridge, UK., Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK., Department of Urology, University Hospitals Leicester, Leicester, UK., Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK., Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK., Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK., Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK., Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK., Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.