title: The cost effectiveness of radiofrequency ablation for Barrett's esophagus.
abstract: OBJECTIVE
  Radiofrequency ablation (RFA) reduces the risk of esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus (BE) with high-grade dysplasia (HGD), but its effects in patients without dysplasia are debatable. We analyzed the effectiveness and cost effectiveness of RFA for the management of BE.
  
  
  METHODS
  We constructed a decision analytic Markov model. We conducted separate analyses of hypothetical cohorts of patients with BE with dysplasia (HGD or low-grade [LGD]) and without dysplasia. In the analysis of the group with HGD, we compared results of initial RFA with endoscopic surveillance with surgery when cancer was detected. In analyzing the group with LGD or no dysplasia, we compared 3 strategies: endoscopic surveillance with surgery when cancer was detected (S1), endoscopic surveillance with RFA when HGD was detected (S2), and initial RFA followed by endoscopic surveillance (S3).
  
  
  RESULTS
  Among patients with HGD, initial RFA was more effective and less costly than endoscopic surveillance. Among patients with LGD, when S3 was compared with S2, the incremental cost-effectiveness ratio was $18,231/quality-adjusted life-year, assuming an annual rate of progression rate from LGD to EAC of 0.5%/year. For patients without dysplasia, S2 was more effective and less costly than S1. In a comparison of S3 with S2, the incremental cost-effectiveness ratios were $205,500, $124,796, and $118,338/quality-adjusted life-year using annual rates of progression of no dysplasia to EAC of 0.12%, 0.33%, or 0.5% per year, respectively.
  
  
  CONCLUSIONS
  By using updated data, initial RFA might not be cost effective for patients with BE without dysplasia, within the range of plausible rates of progression of BE to EAC, and be prohibitively expensive, from a policy perspective. RFA might be cost effective for confirmed and stable LGD. Initial RFA is more effective and less costly than endoscopic surveillance in HGD.
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: chur@partners.org.
authors.forename: Chin
authors.initials: C
authors.lastname: Hur
authors.affiliation: Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Choi
authors.affiliation: Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Joel H
authors.initials: JH
authors.lastname: Rubenstein
authors.affiliation: Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Chung Yin
authors.initials: CY
authors.lastname: Kong
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Norman S
authors.initials: NS
authors.lastname: Nishioka
authors.affiliation: Durham VA Medical Center, Duke University Medical Center, Durham, North Carolina.
authors.forename: Dawn T
authors.initials: DT
authors.lastname: Provenzale
authors.affiliation: Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: John M
authors.initials: JM
authors.lastname: Inadomi
mesh_terms: D000230:Adenocarcinoma / Q000191:economics / Q000473:pathology / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000191:economics*; D003198:Computer Simulation; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal / Q000191:economics*; D004938:Esophageal Neoplasms / Q000191:economics / Q000473:pathology / Q000517:prevention & control; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D018579:Patient Selection; D011230:Precancerous Conditions / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States