A UK-based cost-utility analysis of radiofrequency ablation or oesophagectomy for the management of high-grade dysplasia in Barrett's oesophagus.
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.


OBJECTIVE
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 or (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, it required a radiofrequency ablation treatment failure rate (high-grade dysplasia persistence or progression to cancer) of >44%, or an annual risk of high-grade dysplasia recurrence or progression to cancer in the ablated oesophagus of >15% per annum. There was an 85% probability that radiofrequency ablation remained cost-effective at the NICE willingness to pay threshold range of £20 000-30 000.


CONCLUSIONS
Radiofrequency ablation is likely to be a cost-effective option for high-grade dysplasia in Barrett's oesophagus in the UK.
Department of Luminal Gastroenterology, Southampton General Hospital, UK. philboger@btinternet.com
P C
PC
Boger
D
D
Turner
P
P
Roderick
P
P
Patel
D001471:Barrett Esophagus / Q000191:economics / Q000601:surgery*; D017115:Catheter Ablation / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D016629:Esophagectomy / Q000191:economics* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D006113:United Kingdom