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.