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

Adult Aged Cost-Benefit Analysis Health Care Costs Humans Male Middle Aged Prostatic Neoplasms / therapy Quality-Adjusted Life Years

Journal

British journal of cancer
ISSN: 1532-1827
Titre abrégé: Br J Cancer
Pays: England
ID NLM: 0370635

Informations de publication

Date de publication:
09 2020
Historique:
received: 07 11 2019
accepted: 25 06 2020
revised: 08 06 2020
pubmed: 17 7 2020
medline: 24 3 2021
entrez: 17 7 2020
Statut: ppublish

Résumé

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).

Sections du résumé

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).

Identifiants

DOI: 10.1038/s41416-020-0978-4 PMID: 32669672 PMC: PMC7524753
pubmed: 32669672
doi: 10.1038/s41416-020-0978-4
pii: 10.1038/s41416-020-0978-4
pmc: PMC7524753
doi:

Banques de données

ClinicalTrials.gov
['NCT02044172']

Types de publication

Comparative Study Journal Article Randomized Controlled Trial

Langues

eng

Sous-ensembles de citation

IM

Pagination

1063-1070

Subventions

Organisme : DH | NIHR | Health Technology Assessment Programme (NIHR Health Technology Assessment Programme)
ID : 96/20/06
Organisme : DH | NIHR | Health Technology Assessment Programme (NIHR Health Technology Assessment Programme)
ID : 96/20/99
Organisme : Cancer Research UK (CRUK)
ID : C11043/A4286, C18281/A8145, C18281/A11326, C18281/A15064, and C18281/A24432

Références

Hamdy, F. C., Donovan, J. L., Lane, J. A., Mason, M., Metcalfe, C., Holding, P. et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N. Engl. J. Med. 375, 1415–1424 (2016).
doi: 10.1056/NEJMoa1606220
Donovan, J. L., Hamdy, F. C., Lane, J. A., Mason, M., Metcalfe, C., Walsh, E. et al. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N. Engl. J. Med. 375, 1425–1437 (2016).
doi: 10.1056/NEJMoa1606221
Andersson, S., Andrén, O., Lyth, J., Stark, J. R., Henriksson, M., Adami, H. O. et al. Managing localized prostate cancer by radical prostatectomy or watchful waiting: Cost analysis of a randomized trial (SPCG-4). Scand. J. Urol. Nephrol. 45, 177–183 (2011).
doi: 10.3109/00365599.2010.545075
Wilt, T. J., Brawer, M. K., Jones, K. M., Barry, M. J., Aronson, W. J., Fox, S. et al. Radical prostatectomy versus observation for localized prostate cancer. N. Engl. J. Med. 367, 203–213 (2012).
doi: 10.1056/NEJMoa1113162
Eldefrawy, A., Katkoori, D., Abramowitz, M., Soloway, M. S. & Manoharan, M. Active surveillance vs. treatment for low-risk prostate cancer: a cost comparison. Urologic Oncol.: Semin. Original Investig. 31, 576–580 (2013).
doi: 10.1016/j.urolonc.2011.04.005
Hayes, J. H., Ollendorf, D. A., Pearson, S. D., Barry, M. J., Kantoff, P. W., Lee, P. A. et al. Observation versus initial treatment for men with localized, low-risk prostate cancer: a cost-effectiveness analysis. Ann. Intern. Med. 158, 853–860 (2013).
doi: 10.7326/0003-4819-158-12-201306180-00002
Keegan, K. A., Dall’Era, M. A., Durbin-Johnson, B. & Evans, C. P. Active surveillance for prostate cancer compared with immediate treatment: an economic analysis. Cancer 118, 3512–2518 (2012).
doi: 10.1002/cncr.26688
Koerber, F., Waidelich, R., Stollenwerk, B. & Rogowski, W. The cost-utility of open prostatectomy compared with active surveillance in early localised prostate cancer. BMC Health Serv. Res. 14, 163 (2014).
doi: 10.1186/1472-6963-14-163
Lao, C., Edlin, R., Rouse, P., Brown, C., Holmes, M. & Gilling, P. The cost-effectiveness of active surveillance compared to watchful waiting and radical prostatectomy for low risk localised prostate cancer. BMC Cancer 17, 529 (2017).
doi: 10.1186/s12885-017-3522-z
Lane, J. A., Donovan, J. L., Davis, M., Walsh, E., Dedman, D., Down, L. et al. Active monitoring, radical prostatectomy, or radiotherapy for localised prostate cancer: study design and diagnostic and baseline results of the ProtecT randomised phase 3 trial. Lancet Oncol. 15, 1109–1118 (2014).
doi: 10.1016/S1470-2045(14)70361-4
Manca, A., Hawkins, N. & Sculpher, M. J. Estimating mean QALYs in trial‐based cost‐effectiveness analysis: the importance of controlling for baseline utility. Health Econ. 14, 487–496 (2005).
doi: 10.1002/hec.944
NICE. Guide to the methods of technology appraisal 2013. https://www.nice.org.uk/process/pmg9/chapter/the-reference-case#framework-for-estimating-clinical-and-cost-effectiveness (2013).
StataCorp. Stata Statistical Software: Release 14 (StataCorp LP, College Station, 2015).
Greene, W. H. Econometric analysis 5th edn (Prentice Hall, New Jersey, 2002).
Gluck, H. A., Doshi, J. A., Sonnad, S. S. & Polsky, D. Economic Evaluation in Clinical Trials (Oxford University Press, Oxford, 2007).
Briggs, A. H. A Bayesian approach to stochastic cost-effectiveness analysis. Health Econ. 8, 257–261 (1999).
doi: 10.1002/(SICI)1099-1050(199905)8:3<257::AID-HEC427>3.0.CO;2-E
D’amico, A. V., Whittington, R., Malkowicz, S. B., Schultz, D., Blank, K., Broderick, G. A. et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280, 969–974 (1998).
doi: 10.1001/jama.280.11.969
Inflationtool.com. Inflation calculator. https://www.inflationtool.com/ (2018).
OECD. Purchasing power parities (PPP). https://data.oecd.org/conversion/purchasing-power-parities-ppp.htm#indicator-chart (2018).
Lyth, J., Andersson, S. O., Andren, O., Johansson, J. E., Carlsson, P. & Shahsavar, N. A decision support model for cost-effectiveness of radical prostatectomy in localized prostate cancer. Scand. J. Urol. Nephrol. 46, 19–25 (2012).
doi: 10.3109/00365599.2011.615759
Bill-Axelson, A., Holmberg, L., Garmo, H., Taari, K., Busch, C., Nordling, S. et al. Radical prostatectomy or watchful waiting in prostate cancer—29-year follow-up. N. Engl. J. Med. 379, 2319–2329 (2018).
doi: 10.1056/NEJMoa1807801

Auteurs

Sian M Noble (SM)

Bristol Medical School, University of Bristol, Bristol, UK. s.m.noble@bristol.ac.uk.
ORCID: 0000-0002-8011-0722

Kirsty Garfield (K)

Bristol Medical School, University of Bristol, Bristol, UK.
Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.

J Athene Lane (JA)

Bristol Medical School, University of Bristol, Bristol, UK.
Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.

Chris Metcalfe (C)

Bristol Medical School, University of Bristol, Bristol, UK.
Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.

Michael Davis (M)

Bristol Medical School, University of Bristol, Bristol, UK.

Eleanor I Walsh (EI)

Bristol Medical School, University of Bristol, Bristol, UK.

Richard M Martin (RM)

Bristol Medical School, University of Bristol, Bristol, UK.
National Institute for Health Research, Bristol Biomedical Research Centre, University of Bristol, Bristol, UK.

Emma L Turner (EL)

Bristol Medical School, University of Bristol, Bristol, UK.

Tim J Peters (TJ)

Bristol Medical School, University of Bristol, Bristol, UK.

Joanna C Thorn (JC)

Bristol Medical School, University of Bristol, Bristol, UK.

Malcolm Mason (M)

The School of Medicine, University of Cardiff, Cardiff, UK.

Prasad Bollina (P)

Department of Urology and Surgery, Western General Hospital, Edinburgh, UK.

James W F Catto (JWF)

The Academic Urology Unit, University of Sheffield, Sheffield, UK.

Alan Doherty (A)

Department of Urology, Queen Elizabeth Hospital, Birmingham, UK.

Vincent Gnanapragasam (V)

The Academic Urology Group, University of Cambridge, Cambridge, UK.
Cambridge Urology Translational Research and Clinical Trials Office, Cambridge, UK.

Owen Hughes (O)

Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK.

Roger Kockelbergh (R)

Department of Urology, University Hospitals Leicester, Leicester, UK.

Howard Kynaston (H)

The School of Medicine, University of Cardiff, Cardiff, UK.

Alan Paul (A)

Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Edgar Paez (E)

Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK.

Derek J Rosario (DJ)

Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK.

Edward Rowe (E)

Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK.

Jon Oxley (J)

Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK.

John Staffurth (J)

The School of Medicine, University of Cardiff, Cardiff, UK.

David E Neal (DE)

Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.

Freddie C Hamdy (FC)

Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.

Jenny L Donovan (JL)

Bristol Medical School, University of Bristol, Bristol, UK.

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