A UK BASED COST-UTILITY ANALYSIS OF RADIOFREQUENCY ABLATION OR OESOPHAGECTOMY FOR THE MANAGEMENT OF HIGH-GRADE DYSPLASIA IN BARRETT'S OESOPHAGUS

Philip Christopher Boger (1) , David Turner (2) , Paul Roderick (3) , Praful Patel (4)

1 Luminal Gastroenterology
2 University of Southampton
3 Public Health Sciences and Medical Statistics
4 Luminal Gastroenterology

Background In the UK, oesophagectomy is the current recommendation for patients with persistent high-grade dysplasia in Barrett's oesophagus. Radiofrequency ablation is an alternative new technology with promising early trial results. Aim To undertake a cost utility analysis comparing these two strategies. Methods We constructed a Markov model to simulate the natural history of a cohort of patients with high-grade dysplasia in Barrett's oesophagus undergoing one of two treatment options; (i) Oesophagectomy (ii) Radiofrequency ablation followed by endoscopic surveillance with oesophagectomy for high-grade dysplasia recurrence or persistence. Results In the base case analysis radiofrequency ablation dominated as it generated 0.4 extra quality of life years at a cost saving of £1902. For oesophagectomy to be the most cost effective option requires a radiofrequency ablation treatment failure rate (high-grade dysplasia persistence or progression to cancer) of greater than 44%, or an annual risk of high-grade dysplasia recurrence or progression to cancer in the ablated oesophagus of greater than 15% per annum. There was an 85% probability that radiofrequency ablation remained cost effective at the NICE willingness to pay threshold range of £20000-30000. Conclusion Radiofrequency ablation is likely to be a cost effective option for high-grade dysplasia in Barrett's oesophagus in the UK.

Mots clés: Medicine

Philip Christopher Boger, David Turner, Paul Roderick, Praful Patel. A UK BASED COST-UTILITY ANALYSIS OF RADIOFREQUENCY ABLATION OR OESOPHAGECTOMY FOR THE MANAGEMENT OF HIGH-GRADE DYSPLASIA IN BARRETT'S OESOPHAGUS. Alimentary Pharmacology and Therapeutics, 2010, 32 (11-12), pp.1332. ⟨10.1111/j.1365-2036.2010.04450.x⟩. ⟨hal-00576166⟩