Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial
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 horiz...
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BMJ Publishing Group
2024-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/1/e075704.full |
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| author | Matthew J Ridd Jodi Taylor Jonathan Rees Stephanie MacNeill Emily Sanderson Athene Lane Gordon Taylor Luke A Robles Mandy Fader Nikki Cotterill Margaret Macaulay Sian Noble Madeleine Cochrane Jessica Frost Lucy McGeagh Marcus J Drake Jo Worthington Hashim Hashim |
| author_facet | Matthew J Ridd Jodi Taylor Jonathan Rees Stephanie MacNeill Emily Sanderson Athene Lane Gordon Taylor Luke A Robles Mandy Fader Nikki Cotterill Margaret Macaulay Sian Noble Madeleine Cochrane Jessica Frost Lucy McGeagh Marcus J Drake Jo Worthington Hashim Hashim |
| author_sort | Matthew J Ridd |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-8e075ddbd2924322b3052cd64dab77e3 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-01-01 |
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| spelling | doaj-art-8e075ddbd2924322b3052cd64dab77e32025-08-20T02:13:36ZengBMJ Publishing GroupBMJ Open2044-60552024-01-0114110.1136/bmjopen-2023-075704Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trialMatthew J Ridd0Jodi Taylor1Jonathan Rees2Stephanie MacNeill3Emily Sanderson4Athene Lane5Gordon Taylor6Luke A Robles7Mandy Fader8Nikki Cotterill9Margaret Macaulay10Sian Noble11Madeleine Cochrane12Jessica Frost13Lucy McGeagh14Marcus J Drake15Jo Worthington16Hashim Hashim17professor of primary health care13 Bristol Trials Centre, Population Health Sciences, University of Bristol, Bristol, UKBrockway Medical Centre, Bristol, UKPopulation Health Sciences, University of Bristol, Bristol, UKPopulation Health Sciences, University of Bristol, Bristol, UKPopulation Health Sciences, University of Bristol Medical School, Bristol, UKPublic and Patient Involvement Representative, Bristol, UKNIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK7 School of Health Sciences, University of Southampton, Southampton, Hampshire, UKDepartment of Nursing & Midwifery, University of the West of England, Bristol, UK1 University of Southampton, Southampton, UKPopulation Health Sciences, University of Bristol, Bristol, UKPopulation Health Sciences, University of Bristol, Bristol, UK1 Bristol Trials Centre, University of Bristol, Bristol, UKFaculty of Health and Life Sciences, Oxford Brookes University, Oxford, UKDepartment of Surgery & Cancer, Imperial College London, London, UKPopulation Health Sciences, University of Bristol, Bristol, UKBristol Urological Institute, North Bristol NHS Trust, Bristol, UKObjectives 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.https://bmjopen.bmj.com/content/14/1/e075704.full |
| spellingShingle | Matthew J Ridd Jodi Taylor Jonathan Rees Stephanie MacNeill Emily Sanderson Athene Lane Gordon Taylor Luke A Robles Mandy Fader Nikki Cotterill Margaret Macaulay Sian Noble Madeleine Cochrane Jessica Frost Lucy McGeagh Marcus J Drake Jo Worthington Hashim Hashim Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial BMJ Open |
| title | Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial |
| title_full | Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial |
| title_fullStr | Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial |
| title_full_unstemmed | Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial |
| title_short | Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial |
| title_sort | cost effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms the triumph cluster randomised controlled trial |
| url | https://bmjopen.bmj.com/content/14/1/e075704.full |
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