Cost-utility Analysis of Navigate, a Treatment Decision Aid for Men with Prostate Cancer and Their Partners, in Comparison to Usual Care

Daniel Lindsay; Penelope Schofield; Matthew J Roberts; John Yaxley; Stephen Quinn; Natalie Richards; Mark Frydenberg; Robert Gardiner; Nathan Lawrentschuk; Ilona Juraskova; Declan G Murphy; Louisa G Collins

doi:10.1016/j.euo.2024.08.005

Cost-utility Analysis of Navigate, a Treatment Decision Aid for Men with Prostate Cancer and Their Partners, in Comparison to Usual Care

Eur Urol Oncol. 2024 Aug 23:S2588-9311(24)00189-5. doi: 10.1016/j.euo.2024.08.005. Online ahead of print.

Authors

Affiliations

¹ Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia. Electronic address: daniel.lindsay@qimrberghofer.edu.au.
² Department of Psychology, Swinburne University of Technology, Melbourne, Australia; Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Australia; Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
³ Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Centre for Clinical Research, University of Queensland, Brisbane, Australia; Department of Urology, Redcliffe Hospital, Redcliffe, Australia.
⁴ Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Wesley Urology Clinic, Wesley Hospital, Brisbane, Australia.
⁵ Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Australia.
⁶ Department of Psychology, Swinburne University of Technology, Melbourne, Australia.
⁷ Department of Urology, Cabrini Institute, Cabrini Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
⁸ Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Centre for Clinical Research, University of Queensland, Brisbane, Australia.
⁹ EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia; Department of Surgery, Royal Melbourne Hospital, Melbourne, Australia.
¹⁰ Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, Australia.
¹¹ Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
¹² Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Australia.

PMID: 39181775
DOI: 10.1016/j.euo.2024.08.005

Abstract

Background and objective: Evidence on the cost effectiveness of decision aids to guide management decisions for men with prostate cancer is limited. We examined the cost utility of the Navigate online decision aid for men with prostate cancer in comparison to usual care (no decision aid).

Methods: A Markov model with a 10-yr time horizon was constructed from a government health care perspective. Data from the Navigate trial (n = 302) and relevant published studies were used for model inputs. Incremental costs and quality-adjusted life-years (QALYs) were calculated for the two strategies. One-way and probabilistic sensitivity analyses were undertaken to address model uncertainty.

Key findings and limitations: On average, the Navigate strategy was estimated to cost AU$8899 (95% uncertainty interval [UI] AU$7509-AU$10438) and produce 7.08 QALYs (95% UI 6.73-7.36) in comparison to AU$9559 (95% UI AU$8177-AU$11017) and 7.03 QALYs (95% UI 6.67-7.31) or usual care. The Navigate strategy dominated usual care as it produced cost-savings and higher QALYs, although differences for both outcomes were small over 10 yr. The likelihood of Navigate being cost effective at a conventionally acceptable threshold of AU$50000 per QALY gained was 99.7%. This study is limited by the availability, quality, and choice of the data used in the model.

Conclusions and clinical implications: Use of an online decision aid for men with prostate cancer appears to be cost effective relative to usual care in Australia, driven by the higher acceptance and uptake of active surveillance. Wider implementation of decision aids may better inform men diagnosed with prostate cancer about their management options.

Patient summary: We looked at the cost effectiveness of an online decision aid for guiding Australian men with prostate cancer in choosing a management option. We found that this decision aid was cost effective, mainly because more men chose active surveillance. Decision aids that inform patients about their management options should be more widely used in health care.

Keywords: Active surveillance; Cost-utility analysis; Decision aid; Management options; Prostate cancer.