In the United Kingdom, radiotherapy was the most cost-effective treatment for older men with prostate cancer and those with high-risk disease, while active monitoring was more cost-effective for younger men and those with low-risk disease, according to a study published in the British Journal of Cancer.1 The 3 treatment approaches assessed — active monitoring, radiotherapy, and surgery — were not vastly different in cost-effectiveness, however, suggesting the need for longer follow-up in future research.
“There were remarkably small differences between the treatment groups at a median of 10 years,” wrote Sian M. Noble, PhD, of the University of Bristol in the UK. “The uncertainty reflected in only a 58% probability that the radiotherapy group was the cost-effective option needs to be acknowledged; the result indicates that it is inconclusive as to which treatment over the median 10 years would be the best value for money.”
Given that the findings do not show major differences between care options, cost probably shouldn’t be a major factor driving decision making for patients, according to Tomasz M. Beer, MD, chair of Prostate Cancer Research at the Oregon Health & Science University’s Knight Cancer Institute in Portland, who was not involved in the study.
“It’s quite reassuring that the quality-of-life years achieved and the total costs of care are quite similar across the choices,” Dr Beer told Cancer Therapy Advisor. “I think the reassurance is more to payers than to providers,” he said, because providers make decisions based on each patients’ best interests rather than global cost-effectiveness. Still, he added, “that’s really good news for the ability of patients to choose the best approach for themselves.”
The ProtecT randomized trial compared the cost-effectiveness of active monitoring, surgery, and radiotherapy for the treatment of prostate cancer using quality-adjusted life years (QALY) and adjusted mean costs. The 1643 men enrolled in the trial had been diagnosed with clinically localized prostate cancer as a result of a screening program with population-based PSA testing across 9 UK centers. Patients were randomly selected for 1 of 3 treatment arms: 545 of the men underwent active monitoring, 553 underwent surgery, and 545 underwent radiotherapy.
Based on 2014-2015 prices in British pounds from the National Health Service (NHS), the researchers analyzed costs of follow-up inpatient stays, outpatient visits, emergency department visits and, since April 2005, primary care visits for a median 10 years of follow-up.
The cost-effectiveness analysis relied on 1101 of the originally randomized participants (67% of the total). Adjusted mean costs were £7519 ($11,279 based on 2015 average currency exchange rate) for surgery, £7361 ($11,042) for radiotherapy and £5913 ($8,870) for active monitoring.
“The finding that the active monitoring group had the lowest costs may address clinician concern that active surveillance could be more expensive in the long term because of the need to keep monitoring patients who might ultimately end up having treatment,” the authors noted. “This study shows that at a median [of] 10 years this was not the case.”
Total adjusted mean QALYs were similar across all groups: 7.093 for radiotherapy, 6.976 for active monitoring, and 6.909 for surgery. Based on an incremental cost-effectiveness ratio (ICER) of £12,310 per QALY, radiotherapy was found most cost-effective using the standard UK NICE willingness-to-pay threshold of £20,000 per QALY, with 58% probability.