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Cost-Effectiveness of Photodynamic Therapy for Treatment of Barrett's Esophagus with High Grade Dysplasia

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Abstract

The purpose of this study was to compare the effectiveness and cost-effectiveness of photodynamic therapy (PDT) versus surgical esophagectomy and intensive endoscopic surveillance for patients with Barrett's esophagus and high-grade dysplasia (HGD) who are operative candidates. The results of our Markov Monte Carlo model show that PDT increased life expectancy by 1.8years and quality-adjusted life expectancy (QALE) by 1.65 years when compared to the surveillance strategy. Relative to the esophagectomy strategy, PDT resulted in a greater life expectancy by 0.8 years and 2.17 additional quality-adjusted life years (QALYs). Although PDT cost $20,400 and $7,100 more than surveillance and esophagectomy respectively, the resulting incremental cost-effective ratios (ICERs) of $12,400/QALY and $3,300/QALY are within commonly accepted values. These findings were sensitive to the value assigned to the quality of life after PDT, but only at unrealistic values. In conclusion, PDT increases life expectancy and is cost-effective when compared to endoscopic surveillance and surgical esophagectomy.

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Hur, C., Nishioka, N.S. & Gazelle, G.S. Cost-Effectiveness of Photodynamic Therapy for Treatment of Barrett's Esophagus with High Grade Dysplasia. Dig Dis Sci 48, 1273–1283 (2003). https://doi.org/10.1023/A:1024146823549

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