Background & aims: Endoscopic treatment is recommended for patients with Barrett's esophagus (BE) with high-grade dysplasia, yet clinical management recommendations are inconsistent for patients with BE without dysplasia (NDBE) or with low-grade dysplasia (LGD). We used a comparative modeling analysis to identify optimal management strategies for these patients.
Methods: We used 3 independent population-based models to simulate cohorts of 60-year-old individuals with BE in the United States. We followed each cohort until death without surveillance and treatment (natural disease progression), compared with 78 different strategies of management for patients with NDBE or LGD. We determined the optimal strategy using cost-effectiveness analyses, at a willingness to pay threshold of $100,000 per quality-adjusted life year (QALY).
Results: In the 3 models, the average cumulative incidence of esophageal adenocarcinoma was 111 cases, with costs totaling $5.7 million per 1000 men with BE. Surveillance and treatment of men with BE prevented 23%-75% of cases of esophageal adenocarcinoma , but increased costs to $6.2-$17.3 million per 1000 men with BE. The optimal strategy was surveillance every 3 years for men with NDBE and treatment of LGD after confirmation by repeat endoscopy (incremental cost-effectiveness ratio, $53,044/QALY). The average results for women were consistent with the results for men for LGD management, but the optimal surveillance interval for women with NDBE was 5 years (incremental cost-effectiveness ratio, $36,045/QALY).
Conclusions: Based on analyses from 3 population-based models, the optimal management strategy for patient with BE and LGD is endoscopic eradication, but only after LGD is confirmed by a repeat endoscopy. The optimal strategy for patients with NDBE is endoscopic surveillance, using a 3-year interval for men and a 5-year interval for women.
Keywords: EAC; EET; ICER; RFA; radiofrequency ablation.
Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.
The Cost Effectiveness of Radiofrequency Ablation for Barrett's EsophagusC Hur et al. Gastroenterology 143 (3), 567-575. PMID 22626608.By using updated data, initial RFA might not be cost effective for patients with BE without dysplasia, within the range of plausible rates of progression of BE to EAC, an …
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Surveillance in Patients With Long-Segment Barrett's Oesophagus: A Cost-Effectiveness AnalysisF Kastelein et al. Gut 64 (6), 864-71. PMID 25037191.Based on a Dutch healthcare perspective and assuming a willingness-to-pay threshold of €35.000 per QALY, surveillance with EMR and RFA for HGD or early OAC, and oesophage …
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