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

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

doi:10.1136/bmjopen-2023-075704

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

BMJ Open. 2024 Jan 30;14(1):e075704. doi: 10.1136/bmjopen-2023-075704.

Authors

Madeleine Cochrane¹, Marcus J Drake², Jo Worthington³, Jessica Frost³, Nikki Cotterill⁴, Mandy Fader⁵, Lucy McGeagh⁶, Hashim Hashim⁷, Athene Lane³, Margaret Macaulay⁸, Stephanie MacNeill³, Jonathan Rees⁹, Matthew J Ridd³, Luke A Robles¹⁰, Emily Sanderson³, Gordon Taylor¹¹, Jodi Taylor³, Sian Noble³

Affiliations

¹ Population Health Sciences, University of Bristol, Bristol, UK madeleine.cochrane@bristol.ac.uk.
² Department of Surgery & Cancer, Imperial College London, London, UK.
³ Population Health Sciences, University of Bristol, Bristol, UK.
⁴ Department of Nursing & Midwifery, University of the West of England, Bristol, UK.
⁵ School of Health Sciences, University of Southampton, Southampton, UK.
⁶ Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.
⁷ Bristol Urological Institute, North Bristol NHS Trust Southmead Hospital, Bristol, UK.
⁸ Faculty of Health Sciences, University of Southampton, Southampton, UK.
⁹ Brockway Medical Centre, Bristol, UK.
¹⁰ NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK.
¹¹ Public and Patient Involvement Representative, Bristol, UK.

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.

Trial registration number: ISRCTN11669964.

Keywords: HEALTH ECONOMICS; Primary Health Care; UROLOGY.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Cost-Benefit Analysis
England
Humans
Lower Urinary Tract Symptoms* / therapy
Male
Primary Health Care
Quality of Life
Quality-Adjusted Life Years
State Medicine*