COMPARING COSTS FROM A PRAGMATIC RANDOMISED TRIAL TO PUBLISHED MODELLING-BASED ESTIMATES- AN EXAMPLE FROM PROSTATE-CANCER SCREENING

OBJECTIVES: Decision-analytic models are commonly used when assessing cost-effectiveness, but a pragmatic trial utilising real-world electronic health records can offer detailed, long-term follow-up of healthcare costs at the individual level without the need for modelling. Here, we compare cost estimates derived from information collected 'alongside' a trial to costs estimates derived from models in the literature. METHODS: We perform a systematic literature review to retrieve information on healthcare costs of PSA-based systematic screening for prostate cancer estimated as part of published cost-effectiveness models. In addition, we link and statistically analyse a set of national registers covering prescription medication reimbursements, inpatient care and outpatient care to produce healthcare-cost estimates for men diagnosed with prostate-cancer during the follow-up of the 80000+ men in a prostate-cancer screening trial. RESULTS: The findings concerning the healthcare costs associated with systematic PSA-based screening vary in the literature. From our pragmatic trial-based data, the average cumulative costs were estimated to be significantly lower than those reported in models in the literature. CONCLUSIONS: Although analysis of real-world data may able to provide a useful supplement to results from modelling studies, the validity of such analysis should be assessed on a case-by-case basis. In addition, although analysis using decision-analytic models may be an 'unavoidable fact of life', such analysis should also be assessed for validity on a case-by-case basis. Our results suggest that the way in which 'cost-effectiveness' results from modelling studies are interpreted could benefit from more analysis of costs collected alongside large pragmatic clinical trials.