A cost-effectiveness analysis of endoscopic eradication therapy for management of dysplasia arising in patients with Barrett’s oesophagus in the United Kingdom

Pollit, Vicki; Graham, David Y.; Leonard, Catherine; Filby, Alexandra; McMaster, Jessica; Mealing, Stuart; Lovat, Laurence; Haidry, Rehan

doi:10.1080/03007995.2018.1552407

Cited by 12 publications

(8 citation statements)

References 35 publications

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“…Average proton pump inhibitor (PPI) costs based on UK NHS (National Health Service) tariffs were adjusted into the model [31]. Unit costs for healthcare interventions were based on the NHS national payment tariffs for 2019/20 [32].…”

Section: Costs and Resource Usementioning

confidence: 99%

Comparative cost-effectiveness of three post-radiofrequency ablation surveillance intervals for Barrett’s esophagus

et al. 2022

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Background Radiofrequency ablation (RFA) for dysplastic Barrett’s oesophagus (BO) has resulted in a paradigm shift in the management of BO. Despite widespread adoption of RFA, the optimal surveillance interval of the ablated zone is unclear. Methods A patient-level discrete time cycle Markov model was developed to model clinical surveillance strategies post RFA for BO. Three surveillance strategies were examined: the ‘ACG’ strategy based on ACG guidelines for post-RFA surveillance, the ‘Cotton’ strategy based on data from the USA and UK RFA registries and the ‘UK’ strategy in line with surveillance strategies in UK centres. Monte-Carlo deterministic and probabilistic analyses were performed over 10,000 iterations (i.e., representing 10,000 patient journeys) and sensitivity analyses were carried out on the variables used in the model. Results On base-case analysis, the ACG strategy was the most cost-effective strategy, at a mean cost of £11,733 ($16,396) (standard deviation (SD) 1520.15) and a mean effectiveness of 12.86 (SD 0.07) QALYs. Probabilistic sensitivity analysis demonstrated that the ACG model was the most cost-effective strategy with a net monetary benefit (NMB) of £5,136 ($7177) (SD 241) compared to the UK strategy and a NMB of £7017 ($9,806) (SD 379) compared to the Cotton strategy. At a willingness to pay (WTP) threshold of £20,000 ($27,949), the ACG model was superior to the other strategies as the most cost-effective strategy. Conclusions A post-RFA surveillance strategy based on the ACG guidelines seems to be the most cost-effective surveillance option.

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Section: Costs and Resource Usementioning

confidence: 99%

Comparative cost-effectiveness of three post-radiofrequency ablation surveillance intervals for Barrett’s esophagus

et al. 2022

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“…This trial was designed to derive accuracy data and the sensitivity used is from a per protocol analysis that includes inadequate samples without a repeat examination to provide a conservative, base case. We assumed that the confirmatory endoscopy with biopsy that follows a positive TFF3 test result had an effective sensitivity and specificity of 1 (gold-standard) for the purposes of the model, in line with assumptions taken by previous economic models [ 16 , 17 , 20 ]. This approach takes into account the face validity of a negative endoscopy test in that clinicians typically do not re-order endoscopy following negative findings, even though the sensitivity of endoscopy is less than 100%.…”

Section: Methodsmentioning

confidence: 99%

“…We calculated mean and standard deviation costs for both arms for each cost component and all components combined ( Table 3 ). Utilities and disutilities were derived from the literature (see Appendix) [ 20 , [23] , [24] , [25] ]. Disutilities were applied to stricture (2 weeks), perforation, EMR and RFA surgery (4 weeks), chemotherapy (4.5 months), and esophagectomy (3 months).…”

Section: Methodsmentioning

confidence: 99%

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Economic evaluation of Cytosponge®-trefoil factor 3 for Barrett esophagus: A cost-utility analysis of randomised controlled trial data

et al. 2021

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Background Esophageal adenocarcinoma has a very poor prognosis unless detected early. The Cytosponge-trefoil factor 3 (TFF3) is a non-endoscopic test for Barrett esophagus, a precursor of esophageal adenocarcinoma. Randomised controlled trial data from the BEST3 trial has shown that an offer of Cytosponge-TFF3 in the primary care setting in England to individuals on medication for acid reflux increases detection of Barrett esophagus 10-fold over a year compared with standard care. This is an economic evaluation of Cytosponge-TFF3 screening versus usual care using data from the BEST3 trial which took place between 20th March 2017 and 21st March 2019. Methods A Markov model with a one-year cycle-length and a lifetime time horizon was created, adapting previous modeling work on Cytosponge screening. The impact of one round of Cytosponge screening was modelled in patients with a median age of 69 years (based on BEST3 trial population). Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were conducted on model parameters. Findings Per person, one round of Cytosponge-TFF3 screening, including confirmatory endoscopy and treatment, in the intervention arm costed £82 more than usual care and generated an additional 0.015 quality-adjusted life-years (QALYs) at an ICER of £5,500 per QALY gained. Probabilistic sensitivity analysis gave an ICER of £5,405 (95% CI -£6,791 to £17,600). The average QALY gain per person is small because the majority of patients in the model will not develop BE and therefore will have no resulting change in their utility, however the small proportion of patients who are identified with BE dysplasia or cancer derive large benefit. At a willingness-to-pay threshold of £20,000 per QALY, the probability that Cytosponge-TFF3 was cost-effective was over 90%. Interpretation Using data from a pragmatic randomised trial, one-off Cytosponge-TFF3 screen is cost-effective relative to usual care for patients with gastro-esophageal reflux disease, despite relatively low uptake and an older population in this trial setting than previously modelled. Improving Cytosponge-TFF3 uptake and targeting younger patients is likely to further improve cost-effectiveness.

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“…A recent cost-effectiveness analysis was conducted for endoscopic eradication therapy (EET) for treatment of all grades of dysplasia in Barrett’s oesophagus patients [ 102 ]. EET for patients with LGD and HGD arising in Barrett’s oesophagus was deemed as cost-effective compared to endoscopic surveillance alone (lifetime £3,006 per QALY gained) by Pollit et al [ 102 ] The authors further concluded that as the time elapses, the treatment becomes more cost-effective. The 5-year financial impact to the UK National Health Service (NHS) of introducing EET is £7.1 m [ 102 , 103 ].…”

Section: Introductionmentioning

confidence: 99%

Towards screening Barrett’s oesophagus: current guidelines, imaging modalities and future developments

Maitra

Date

Martin³

2020

Clin J Gastroenterol

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Barrett’s oesophagus is the only known precursor to oesophageal adenocarcinoma (OAC). Although guidelines on the screening and surveillance exist in Barrett’s oesophagus, the current strategies are inadequate. Oesophagogastroduodenoscopy (OGD) is the gold standard method in screening for Barrett’s oesophagus. This invasive method is expensive with associated risks negating its use as a current screening tool for Barrett’s oesophagus. This review explores current definitions, epidemiology, biomarkers, surveillance, and screening in Barrett’s oesophagus. Imaging modalities applicable to this condition are discussed, in addition to future developments. There is an urgent need for an alternative non-invasive method of screening and/or surveillance which could be highly beneficial towards reducing waiting times, alleviating patient fears and reducing future costs in current healthcare services. Vibrational spectroscopy has been shown to be promising in categorising Barrett’s oesophagus through to high-grade dysplasia (HGD) and OAC. These techniques need further validation through multicentre trials.

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A cost-effectiveness analysis of endoscopic eradication therapy for management of dysplasia arising in patients with Barrett’s oesophagus in the United Kingdom

Cited by 12 publications

References 35 publications

Comparative cost-effectiveness of three post-radiofrequency ablation surveillance intervals for Barrett’s esophagus

Comparative cost-effectiveness of three post-radiofrequency ablation surveillance intervals for Barrett’s esophagus

Economic evaluation of Cytosponge®-trefoil factor 3 for Barrett esophagus: A cost-utility analysis of randomised controlled trial data

Towards screening Barrett’s oesophagus: current guidelines, imaging modalities and future developments

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