Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: The TRIUMPH cluster randomised controlled trial

Cochrane, Madeleine; Drake, Marcus J; Worthington, Jo; Frost, Jessica; Cotterill, Nikki; Fader, Mandy; McGeagh, Lucy; Hashim, Hashim; Lane, Athene; Macaulay, Margaret; MacNeill, Stephanie; Rees, Jonathan; Ridd, Matthew J.; Robles, Luke A.; Sanderson, Emily; Taylor, Gordon; Taylor, Jodi; Noble, Sian

Abstract

Objectives To estimate the cost-effectiveness of a primary care intervention for male lower urinary tract symptoms (LUTS) compared with usual care. Design Economic evaluation alongside a cluster randomised controlled trial from a UK National Health Service (NHS) perspective with a 12-month time horizon. Setting Thirty NHS general practice sites in England. Participants 1077 men aged 18 or older identified in primary care with bothersome LUTS. Interventions A standardised and manualised intervention for the treatment of bothersome LUTS was compared with usual care. The intervention group (n=524) received a standardised information booklet with guidance on conservative treatment for LUTS, urinary symptom assessment and follow-up contacts for 12 weeks. The usual care group (n=553) followed local guidelines between general practice sites. Measures Resource use was obtained from electronic health records, trial staff and participants, and valued using UK reference costs. Quality-adjusted life-years (QALYs) were calculated from the EQ-5D-5L questionnaire. Adjusted mean differences in costs and QALYs and incremental net monetary benefit were estimated. Results 866 of 1077 (80.4%) participants had complete data and were included in the base-case analysis. Over the 12-month follow-up period, intervention and usual care arms had similar mean adjusted costs and QALYs. Mean differences were lower in the intervention arm for adjusted costs −£29.99 (95% CI −£109.84 to £22.63) while higher in the intervention arm for adjusted QALYs 0.001 (95% CI −0.011 to 0.014). The incremental net monetary benefit statistic was £48.01 (95% CI −£225.83 to £321.85) at the National Institute for Health and Care Excellence UK threshold of £20 000 per QALY. The cost-effectiveness acceptability curve showed a 63% probability of the intervention arm being cost-effective at this threshold. Conclusions Costs and QALYs were similar between the two arms at 12 months follow-up. This indicates that the intervention can be implemented in general practice at neutral cost.

Citation

Cochrane, M., Drake, M. J., Worthington, J., Frost, J., Cotterill, N., Fader, M., …Noble, S. (2024). Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: The TRIUMPH cluster randomised controlled trial. BMJ Open, 14(1), Article e075704. https://doi.org/10.1136/bmjopen-2023-075704

• Journal Article Type: Article
• Acceptance Date: Dec 4, 2023
• Online Publication Date: Jan 30, 2024
• Publication Date: Jan 31, 2024
• Deposit Date: Feb 19, 2024
• Publicly Available Date: Feb 19, 2024
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Issue: 1
• Article Number: e075704
• DOI: https://doi.org/10.1136/bmjopen-2023-075704
• Keywords: urology, health economics, primary health care
• Public URL: https://uwe-repository.worktribe.com/output/11652037