A UK‐based cost–utility analysis of radiofrequency ablation or oesophagectomy for the management of high‐grade dysplasia in Barrett’s oesophagus

• Published in: Alimentary pharmacology & therapeutics 2010-12, Vol.32 (11‐12), p.1332-1342
• Main Authors: Boger, P. C., Turner, D., Roderick, P., Patel, P.
• Format: Article
• Language: English
• Subjects: Barrett Esophagus - economics; Barrett Esophagus - surgery; Biological and medical sciences; Catheter Ablation - economics; Catheter Ablation - methods; Cost-Benefit Analysis; Digestive system; Esophagectomy - economics; Esophagectomy - methods; Esophagus; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Male; Medical sciences; Middle Aged; Models, Economic; Other diseases. Semiology; Pharmacology. Drug treatments; Quality-Adjusted Life Years; United Kingdom
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2010.04450.x

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.