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Surveillance in patients with long-segment Barrett's oesophagus: a cost-effectiveness analysis
  1. F Kastelein1,
  2. S van Olphen1,2,
  3. E W Steyerberg3,
  4. M Sikkema1,4,
  5. M C W Spaander1,
  6. C W N Looman3,
  7. E J Kuipers1,
  8. P D Siersema1,4,
  9. M J Bruno1,
  10. E W de Bekker-Grob3,
  11. on behalf of the ProBar-study group
  1. 1Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
  2. 2Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
  3. 3Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
  4. 4Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Florine Kastelein, Department of Gastroenterology and Hepatology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; f.kastelein{at}erasmusmc.nl

Abstract

Objective Surveillance is recommended for Barrett's oesophagus (BO) to detect early oesophageal adenocarcinoma (OAC). The aim of this study was to evaluate the cost-effectiveness of surveillance.

Design We included 714 patients with long-segment BO in a multicentre prospective cohort study and used a multistate Markov model to calculate progression rates from no dysplasia (ND) to low-grade dysplasia (LGD), high-grade dysplasia (HGD) and OAC. Progression rates were incorporated in a decision-analytic model, including costs and quality of life data. We evaluated different surveillance intervals for ND and LGD, endoscopic mucosal resection (EMR), radiofrequency ablation (RFA) and oesophagectomy for HGD or early OAC and oesophagectomy for advanced OAC. The incremental cost-effectiveness ratio (ICER) was calculated in costs per quality-adjusted life-year (QALY).

Results The annual progression rate was 2% for ND to LGD, 4% for LGD to HGD or early OAC and 25% for HGD or early OAC to advanced OAC. Surveillance every 5 or 4 years with RFA for HGD or early OAC and oesophagectomy for advanced OAC had ICERs of €5.283 and €62.619 per QALY for ND. Surveillance every five to one year had ICERs of €4.922, €30.067, €32.531, €41.499 and €75.601 per QALY for LGD. EMR prior to RFA was slightly more expensive, but important for tumour staging.

Conclusions Based on a Dutch healthcare perspective and assuming a willingness-to-pay threshold of €35.000 per QALY, surveillance with EMR and RFA for HGD or early OAC, and oesophagectomy for advanced OAC is cost-effective every 5 years for ND and every 3 years for LGD.

  • BARRETT'S CARCINOMA
  • BARRETT'S METAPLASIA
  • BARRETT'S OESOPHAGUS
  • OESOPHAGEAL CANCER
  • COST-EFFECTIVENESS

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