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

Authors

  • P. C. Boger,

    1. Department of Luminal Gastroenterology, MP CF91, Level F Centre Block, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
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  • D. Turner,

    1. Wessex Institute University of Southampton, Alpha House, Enterprise Rd, Southampton Science Park, Chilworth, Southampton SO16 7NS, UK.
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  • P. Roderick,

    1. Public Health Sciences and Medical Statistics, C Floor, South Academic Block, Southampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UK.
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  • P. Patel

    1. Department of Luminal Gastroenterology, MP CF91, Level F Centre Block, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
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Dr P. C. Boger, Department of Luminal Gastroenterology, MP CF91, Level F Centre Block, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
E-mail: philboger@btinternet.com

Abstract

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.

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