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.

• 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