OBJECTIVES:

Monitoring with regular computed tomography (CT) is an effective means of identifying relapse in patients treated for stage I seminoma testis; however, risks of radiation exposure are a major concern in these young patients, many of whom won’t relapse. The TRISST randomized trial assessed whether a reduced CT or Magnetic Resonance Imaging (MRI) schedule could be effective alternatives to standard CT-based surveillance. It found that fewer CTs or MRIs were non-inferior in terms of clinical outcomes. This study used the TRISST trial data to evaluate the health care resource consequences and health-related quality-of-life of different surveillance strategies in patients with seminoma testicular cancer in the UK.

METHODS:

669 men were randomized to 4 surveillance groups: 7CTs, 3CTs, 7MRIs or 3MRIs of the retroperitoneum. Resource use (incl. investigations, scans, hospitalisations and relapse treatment) and health outcomes data (EQ-5D-3L) were collected at baseline and for 6 years after randomization. Health care resources were costed using publicly available national unit costs. Using a UK NHS perspective, cost-effectiveness was evaluated using cost per quality-adjusted life-year (QALY) gained. Regression modelling was used to explore variation in total costs and QALYs. Scenario and probabilistic analyses were performed to evaluate results robustness.

RESULTS:

Patients undergoing 7MRIs yielded the most QALYs (5.57, SE=0.052), but also generated the highest costs (£6,275, SE=289.062). The Incremental Cost-Effectiveness Ratio (ICER) of this strategy, compared to the next best alternative 7CTs (5.53 QALYs, SE=0.036; £5,757, SE=333.423), was £13,752/QALY gained. The 3CTs schedule (5.497 QALYs, SE=0.040; £6,096, SE=315.567) was dominated. Although the 3MRIs group incurred the least costs (£5,755, SE=321.661), the amount of QALYs accrued (5.498, SE=0.037) was smaller.

CONCLUSIONS:

Cost savings from reduced number of CT scans are not offset by the increased cost of recurrence management. Longer MRI surveillance schedules yield more health benefits than other strategies with a higher cost.