The latest results from the Prostate Testing for Cancer and Treatment (ProtecT) randomised controlled trial suggest radiotherapy is the most cost-effective treatment for localised prostate cancer.
The study compared the cost-effectiveness of active monitoring, surgery and radiotherapy from a UK NHS perspective at 10 years’ median follow-up.
The findings, reported in the British Journal of Cancer, show adjusted mean quality-adjusted life-years (QALYs) of 6.89 with active monitoring, 7.09 with radiotherapy and 6.91 with 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 National Institute for Clinical Excellence (NICE) willingness-to-pay threshold of £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.
Over the median 10-year period, the mean cost-difference between the radiotherapy and surgery groups was only £159.
This study is the first and only economic evaluation within a randomised trial comparing the three contemporary major treatment modalities.
The authors say longer follow-up and modelling are required to determine the most cost-effective treatment for localised prostate cancer over a man’s lifetime.
Noble SM, Garfield K, Lane JA, Metcalfe C, Davis M, Walsh EI, Martin RM, Turner EL, Peters TJ, Thorn JC, Mason M, Bollina P, Catto JWF, Doherty A, Gnanapragasam V, Hughes O, Kockelbergh R, Kynaston H, Paul A, Paez E, Rosario DJ, Rowe E, Oxley J, Staffurth J, Neal DE, Hamdy FC, Donovan JL. The ProtecT randomised trial cost-effectiveness analysis comparing active monitoring, surgery, or radiotherapy for prostate cancer. Br J Cancer. 2020 Jul 16 [Epub ahead of print]. doi: 10.1038/s41416-020-0978-4. PMID: 32669672. Full text.
This article originally appeared on Univadis, part of the Medscape Professional Network.
