The Navigate randomized controlled trial ran between May 2017 and May 2021 across seven treatment centers in Victoria and Queensland, Australia for men with recently diagnosed prostate cancer and their partners. The intervention group had access to the Navigate online decision aid tool, which provided textual, graphical, and audio-visual content tailored to the local healthcare context to describe and compare different management options. The usual care group received standard counseling and information from their treating urologist but did not have access to Navigate. All outcomes were collected up to 6 months follow-up.
Presenting personalized information through decision aids such as Navigate may help patients and their families engage in evidence-driven decision-making considering the benefits and costs of available management options. No existing decision aid fully addresses the needs of men with prostate cancer and there is a lack of evidence for the cost-effectiveness of decision aids to guide treatment options for men with prostate cancer.
We undertook a Markov cohort model to assess the cost-utility of Navigate over a 10-year period. We took a government healthcare perspective and the main measure of benefit was quality-adjusted life years. Data inputs were obtained from the Navigate randomized control trial, and epidemiological, health utility, and healthcare cost studies. Incremental cost-effectiveness ratios were calculated as the difference in costs of Navigate and usual care divided by the difference in QALYs or life years. We performed analyses to determine the cost-utility of Navigate if it were implemented in different countries, altering the proportion of men with prostate cancer managed by active surveillance to align with reported values in each country (USA = 48%, UK = 73%, Sweden = 86%) and compared with Australia (80%) as the referent.
Over 10 years, Navigate was superior to usual care and the likelihood that Navigate was cost-effective was 99.7%. Using USA and UK active surveillance rates, costs were relatively higher, and QALYs relatively lower than in the Australian case. In contrast,e the higher active surveillance rates in Sweden resulted in superior cost-effectiveness than Australia. It appears that Navigate becomes most cost-effective as the proportion of men managed by active surveillance increases.
To our knowledge, this is the first economic evaluation of a decision aid for men with prostate cancer. We found that Navigate was the superior option compared with usual care, showing overall small cost savings and higher QALYs. Navigate became more cost-effective with increasing national rates of active surveillance uptake, with even a slight increase in this rate enhancing healthcare cost savings and benefits to patients. There has been an increasing global trend in active surveillance uptake, and the greater use of decision aids to educate men with prostate cancer about their management options may encourage further increases.
By providing information comparing active surveillance with active treatments, decision aids may contribute to a better understanding of the lower costs men with prostate cancer will incur, and potential negative side-effects avoided, when assessing the trade-offs of active surveillance over active treatment. Wider implementation of decision aids can help to educate men with prostate cancer, their partners, and families about the management options available to them, helping patients make more informed decisions.
Written by: Daniel Lindsay,1 Penelope Schofield,2 Matthew J Roberts,3 John Yaxley,4 Stephen Quinn,5 Natalie Richards,6 Mark Frydenberg,7 Robert Gardiner,8 Nathan Lawrentschuk,9 Ilona Juraskova,10 Declan G Murphy,11 Louisa G Collins12
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia.
- 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.
- 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.
- 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.
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Australia.
- Department of Psychology, Swinburne University of Technology, Melbourne, Australia.
- Department of Urology, Cabrini Institute, Cabrini Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
- 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.
- 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.
- Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, Australia.
- Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
- 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.