Introduction Endoscopic surveillance and therapy with endoscopic mucosal resection and radio-frequency ablation have an established role in dysplasia in Barrett’s oesophagus (BO). However, the most cost-effective strategy in non-dysplastic BO remains uncertain. Aspirin and Statins are associated with a reduced risk of oesophageal adenocarcinoma. We have examined the cost-effectiveness of Aspirin and Statins without endoscopic surveillance in non-dysplastic BO in comparison with other potential strategies.
Method A Markov model was created using a base population of 1,000 50-year old Caucasian males with non-dysplastic BO followed to 75 years of age. All subjects were assumed fit for oesophagectomy. Subjects on Aspirin and Statin therapy did not undergo surveillance and this cohort was compared with subjects undergoing endoscopic surveillance at 1, 2, 3, 4 and 5-yearly intervals with endoscopic therapy used to treat dysplasia. These cohorts were referenced to a base population who did not undergo surveillance and in whom the natural history was modelled. Cost-effectiveness was expressed as net amount per quality adjusted life year (QALY) and base-costs for treatment were obtained from the Department of Health HRG tariffs for 2014. Monte Carlo simulation and probabilistic sensitivity analysis were carried out.
Results The most cost-effective strategy was 2-yearly surveillance of non-dysplastic BO with an average cost per subject of £5184, yielding 14.69 QALY and an ICER of 21763. Aspirin and Statin therapy without surveillance resulted in a cost of £1735 per subject and 14.23 QALY and was more cost-effective than no surveillance, due to an overall reduction in the incidence of dysplasia with Aspirin and Statins. However, a strategy of using Aspirin and Statins was not as cost-effective as 2-yearly, 3-yearly or 5-yearly surveillance with endoscopic therapy for dysplasia, due to the cost of palliation of incident advanced cancers in the Aspirin and Statin population (not undergoing surveillance).
Conclusion Aspirin and Statin therapy in non-dysplastic BO is more cost-effective than no surveillance but is less cost-effective than endoscopic surveillance and therapy for incident dysplasia. The most cost-effective strategy for all patients for BO remains 2-yearly surveillance.
Disclosure of interest None Declared.