Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Cost-effectiveness analysis of the Navigate online treatment decision aid for men with prostate cancer and their partners (#348)

Daniel Lindsay 1 , Penelope Schofield 2 , Matthew Roberts 3 , John Yaxley 4 , Robert ('Frank') Gardiner 5 , Steve Quinn 6 , Natalie Richards 7 , Allan White 7 , Fiona White 7 , Mark Frydenberg 8 , Suzanne Chambers 9 , Declan Murphy 10 , Lawrence Cavedon 11 , Ilona Juraskova 12 , Louisa Gordon 1
  1. QIMR Berghofer Medical Research Institute, Herston, QUEENSLAND, Australia
  2. Department of Psychology, Swinburne University, Melbourne, Victoria, Australia
  3. Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
  4. Wesley Urology Clinic, Wesley Hospital, Brisbane, QLD, Australia
  5. Faculty of Medicine, University of Queensland, Brisbance, Qld, Australia
  6. Department of Health Science and Biostatistics, Swinburne University , Melbourne, Victoria, Australia
  7. Behaviourial Science Unit, Peter MacCallum Department of Oncology, Melbourne, Victoria, Australia
  8. Department of Urology, Cabrini Institute, Melbourne, Victoria, Australia
  9. Faculty of Health Sciences, Australian Catholic University, Brisbane, Qld, Australia
  10. Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
  11. School of Science, RMIT University, Melbourne, Victoria, Australia
  12. School of Psychology, University of Sydney, Sydney, NSW, Australia

Background and Aim: Men with prostate cancer in active surveillance are proactively monitored with regular prostate-antigen blood tests and biopsies to detect possible disease progression, with active (curative) treatment started as required. We examined the cost-effectiveness of the Navigate online decision aid guiding the choice of management option for men with prostate cancer compared with usual care (no decision aid).

Methods: A decision-analytic cohort model was constructed over a 10-year time horizon. Navigate trial data (n = 302) and estimates from relevant published studies were used for model inputs. The model incorporated costs and benefits over the short and long term, with disease progression occurring in some men. Incremental costs and health effects (quality-adjusted life years, QALYs) were calculated for the two strategies from a government healthcare cost perspective. One-way and probabilistic sensitivity analyses were undertaken to address uncertainty in model inputs.

Results: The estimated mean cost per patient in the Navigate strategy was $8,789 (95% Uncertainty Interval (UI): $7,410, $10,273) and mean QALYs were 7.08 (95% UI: 6.72, 7.36) compared with $9,373 (95% UI: $8,081, $10,808) and 7.03 (95% UI: 6.67, 7.30) for the usual care group. The Navigate strategy produced cost-savings and higher QALYs, albeit small differences in both over 10 years. The findings were sensitive to the uptake of active surveillance, the cost of active treatment (i.e., surgery, radiation therapy), model duration and the probability of disease progression after active treatment, but variation in these did not alter the overall findings. The likelihood of Navigate being cost-effective was 99.8% at the acceptable level in Australia.

Conclusion: Using an online decision aid tool for men with prostate cancer appears to be cost-effective relative to usual practice in the Australian healthcare system, driven by the high acceptance and uptake of active surveillance.