title: [Endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) in neoplastic Barrett's esophagus or Barrett early cancer is also economically superior to sole radical endoscopic resection].
abstract: BACKGROUND
  Neoplastic changes (mild or high grade intraepithelial neoplasia (L- or HGIEN) or early cancer) in Barrett esophagus are treated with various methods. This study compares clinical-economical aspects of sole stepwise radical endoscopic resection (SRER) against combination treatment with EMR (Endoscopic mucosal resection) and RFA (radiofrequency ablation).
  
  
  METHODS
  Based on clinical data from a randomized controlled trial 1 we developed an economic model for costs of treatment according to the German Hospital Remuneration System (G-DRG). Our calculating incorporated initial treatment costs and the cost of treating complications (both paid via G-DRG).
  
  
  RESULTS
  Medical and economically, the treatment with EMR + RFA advantages over sole SRER treatment 1. The successful complete resection or destruction of neoplastic intestinal metaplastic tissue is similar in both procedures. Acute complications (24 vs. 13 % in SRER EMR + RFA) and late complications (88 vs. 13 % in SRER EMR + RFA) are significantly more likely in sole SRER than in the EMR + RFA.
  
  
  CONCLUSIONS
  While SRER initially appears more cost-effective as a sole therapy, cost levels move significantly above EMR+RFA due to higher complication rates and following procedures costs. Overall, the costs of treatment was € 13 272.11 in the SRER group and € 11 389.33 in the EMR + RFA group. The EMR + RFA group thus achieved a cost advantage of € 1882.78. The study shows that the treatment of neoplastic Barrett esophagus with EMR + RFA is also appropriate in economic terms.
authors.affiliation: Dr. Wilke GmbH, München, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wilke
authors.affiliation: Dr. Wilke GmbH, München, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Rathmayer
authors.affiliation: Dr. Wilke GmbH, München, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schenker
authors.affiliation: Gastroenterologie, KH Bogenhausen, München, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Schepp
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000191:economics* / Q000601:surgery*; D017115:Catheter Ablation / Q000191:economics* / Q000706:statistics & numerical data; D015984:Causality; D003131:Combined Modality Therapy / Q000191:economics / Q000706:statistics & numerical data; D015897:Comorbidity; D003198:Computer Simulation; D003362:Cost-Benefit Analysis / Q000191:economics; D000071041:Esophageal Mucosa / Q000601:surgery; D004938:Esophageal Neoplasms / Q000191:economics* / Q000601:surgery*; D004945:Esophagoscopy / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D015995:Prevalence