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A UK‐based cost–utility analysis of radiofrequency ablation or oesophagectomy for the management of high‐grade dysplasia in Barrett’s oesophagus
Author(s) -
Boger P. C.,
Turner D.,
Roderick P.,
Patel P.
Publication year - 2010
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2010.04450.x
Subject(s) - medicine , radiofrequency ablation , dysplasia , esophagectomy , ablation , surgery , esophageal cancer , cancer
Aliment Pharmacol Ther 2010; 32: 1332–1342 Summary Background In the UK, oesophagectomy is the current recommendation for patients with persistent high‐grade dysplasia in Barrett’s oesophagus. Radiofrequency ablation is an alternative new technology with promising early trial results. Aim To undertake a cost–utility analysis comparing these two strategies. Methods We constructed a Markov model to simulate the natural history of a cohort of patients with high‐grade dysplasia in Barrett’s oesophagus undergoing one of two treatment options: (i) oesophagectomy or (ii) radiofrequency ablation followed by endoscopic surveillance with oesophagectomy for high‐grade dysplasia recurrence or persistence. Results In the base case analysis, radiofrequency ablation dominated as it generated 0.4 extra quality of life years at a cost saving of £1902. For oesophagectomy to be the most cost‐effective option, it required a radiofrequency ablation treatment failure rate (high‐grade dysplasia persistence or progression to cancer) of >44%, or an annual risk of high‐grade dysplasia recurrence or progression to cancer in the ablated oesophagus of >15% per annum. There was an 85% probability that radiofrequency ablation remained cost‐effective at the NICE willingness to pay threshold range of £20 000–30 000. Conclusion Radiofrequency ablation is likely to be a cost‐effective option for high‐grade dysplasia in Barrett’s oesophagus in the UK.