Original ResearchClinical—Alimentary TractThe Cost Effectiveness of Radiofrequency Ablation for Barrett's Esophagus
Section snippets
Model Design
A decision-analytic Markov-state transition model was constructed in TreeAge Pro (TreeAge, Williamstown, MA). Health states in the model included Barrett's esophagus (no dysplasia [ND]), LGD, HGD, completely eradicated intestinal metaplasia or dysplasia after RFA, buried crypt after RFA, after successful esophagectomy for cancer, inoperable or an incomplete resection of cancer, and death. Possible causes of death included age-related mortality, surgical mortality, EAC, and RFA complications.
Base-Case Results
The base-case analyses of the HGD and LGD cohorts are presented in Table 2. For the HGD analysis, the surveillance strategy with esophagectomy at the detection of cancer was dominated by the initial RFA strategy, resulting in 0.704 more QALYs and costing $25,609. For the LGD patients, surveillance with esophagectomy for cancer was dominated by the surveillance with RFA at HGD, with the latter strategy resulting in 0.17 more QALYs and costing $7446 less. In LGD patients, when comparing initial
Discussion
Our analysis found that radiofrequency ablation of Barrett's HGD appears appropriate because it is more effective and less costly than continued endoscopic surveillance with surgery when cancer is confirmed by biopsy.
The ablation of LGD costs more than continued surveillance with RFA when HGD is found; however, the improvement in QALYs results in an ICER that is below our willingness to pay threshold of $100,000/QALY, making it the most plausible strategy in terms of cost effectiveness. The
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This article has an accompanying continuing medical education activity on page e20. Learning Objective: Upon completion of this educational exercise, successful learners will be able to demonstrate have an enhanced comprehension of cost-effectiveness analysis as applied to radiofrequency ablation for different grades of Barrett's esophagus.
Conflicts of interest N.S.N.: Research support from BARRX Medical as a site for the HALO Patient Registry Study.
Funding Supported by National Institutes of Health grants R01-CA140574 (C.H.), U01-CA152926 (C.H. and J.M.I.), K25-CA133141 (C.Y.K.), K23DK079291 (J.H.R.), and R03 DK089150 (J.H.R.).
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government (D.T.P.).