Modeling the cost-effectiveness of strategies for treating esophageal adenocarcinoma and high-grade dysplasia

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Gordon, Louisa G
Hirst, Nicholas G
Mayne, George C
Watson, David Ian
Bright, Tim Flaxman
Cai, Wang
Barbour, Andrew P
Smithers, B Mark
Whiteman, David C
Eckermann, Simon Douglas
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© 2012 The Society for Surgery of the Alimentary Tract
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Society for Surgery of the Alimentary Tract
Objective: To synthesize cost and health outcomes for current treatment pathways for esophageal adenocarcinoma and high grade dysplasia, and model comparative net clinical and economic benefits of alternative management scenarios. Methods: A decision-analytic model of real-world practices for esophageal adenocarcinoma treatment by tumor stage was constructed and validated. The model synthesized treatment probabilities, survival, quality-of-life and resource use extracted from epidemiological datasets, published literature and expert opinion. Comparative analyses between current practice and five hypothetical scenarios for modified treatment were undertaken. Results: Over five years, outcomes across T stage ranged from 4.06 quality-adjusted life-years and costs of $3,179 for high grade dysplasia, to 1.62 and $50,226 for stage T4. Greater use of endoscopic mucosal resection for stage T1 and measures to reduce esophagectomy mortality to 0-3% produced modest gains whereas a 20% reduction in the proportion of patients presenting at stage T3 produced large incremental net benefits of $4,971 (95% interval: $1,560, $8,368). Conclusion: These findings support measures that promote earlier diagnosis, such as developing risk assessment processes or endoscopic surveillance of Barrett’s esophagus. Incremental net monetary benefits for other strategies are relatively small in comparison to predicted gains from early detection strategies.
Author version made available in accordance with the publisher's policy.
Cost-benefit analysis, Barrett esophagus, Treatment
Gordon LG, Hirst NG, Mayne GC, Watson DI, Bright T, Cai W, Barbour AP, Smithers BM, Whiteman DC, Eckermann S; Australian Cancer Study Clinical Follow-Up Study Group. Modeling the cost-effectiveness of strategies for treating esophageal adenocarcinoma and high-grade dysplasia. Journal of Gastrointestinal Surgery. 2012 Aug;16(8):1451-61.