期刊
BRITISH JOURNAL OF CANCER
卷 123, 期 7, 页码 1063-1070出版社
SPRINGERNATURE
DOI: 10.1038/s41416-020-0978-4
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资金
- UK National Institute for Health Research, Health Technology Assessment Programme [96/20/06, 96/20/99]
- National Institute for Health Research Bristol Biomedical Research Centre
- Cancer Research UK [C18281/A19169]
- CAP trial - Cancer Research UK
- UK Department of Health [C11043/A4286, C18281/A8145, C18281/A11326, C18281/A15064, C18281/A24432]
- Bristol Randomised Trials Collaboration (BRTC), a UKCRC as part of the Bristol Trials Centre
- National Institute for Health Research CTU
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) pound than radiotherapy (0361) and surgery (7519) pound. Radiotherapy was the most likely (58% probability) cost-effective option at the UK NICE willingness-to-pay threshold (20,000 pound 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.
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