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


Boger, P.C., Turner, D., Roderick, P. and Patel, Praful (2010) A UK-based cost-utility analysis of radiofrequency ablation or oesophagectomy for the management of high-grade dysplasia in Barrett's oesophagus. Alimentary Pharmacology and Therapeutics, 32, (11-12), 1332-1342. (doi:10.1111/j.1365-2036.2010.04450.x).

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Description/Abstract

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.

Item Type: Article
ISSNs: 0269-2813 (print)
1365-2036 (electronic)
Related URLs:
Subjects: R Medicine > R Medicine (General)
R Medicine > RD Surgery
Divisions: University Structure - Pre August 2011 > School of Medicine > Community Clinical Sciences
ePrint ID: 175657
Date Deposited: 25 Feb 2011 10:23
Last Modified: 27 Mar 2014 19:21
URI: http://eprints.soton.ac.uk/id/eprint/175657

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