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

Gordon, Louisa G., Hirst, Nicholas G., Mayne, George C., Watson, David I., Bright, Timothy, Cai, Wang, Barbour, Andrew P., Smithers, Bernard M., Whiteman, David C. and Eckermann, Simon (2012) Modeling the cost-effectiveness of strategies for treating esophageal adenocarcinoma and high-grade dysplasia. Journal of Gastrointestinal Surgery, 16 8: 1451-1461. doi:10.1007/s11605-012-1911-9

Author Gordon, Louisa G.
Hirst, Nicholas G.
Mayne, George C.
Watson, David I.
Bright, Timothy
Cai, Wang
Barbour, Andrew P.
Smithers, Bernard M.
Whiteman, David C.
Eckermann, Simon
Total Author Count Override 10
Title Modeling the cost-effectiveness of strategies for treating esophageal adenocarcinoma and high-grade dysplasia
Journal name Journal of Gastrointestinal Surgery   Check publisher's open access policy
ISSN 1091-255X
Publication date 2012-08
Sub-type Article (original research)
DOI 10.1007/s11605-012-1911-9
Volume 16
Issue 8
Start page 1451
End page 1461
Total pages 11
Place of publication New York, NY, United States
Publisher Springer
Collection year 2013
Language eng
Formatted abstract
Objective: This study aims to synthesize cost and health outcomes for current treatment pathways for esophageal adenocarcinoma and high-grade dysplasia (HGD) and to 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 5 years, outcomes across T stage ranged from 4.06 quality-adjusted life-years and costs of $3,179 for HGD to 1.62 quality-adjusted life-years and costs of $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.
Keyword Adenocarcinoma of the esophagus
Endoscopic mucosal resection
Decision-analytic model
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online: 30 May 2012.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
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