Economic evaluation of endoscopic radiofrequency ablation for the treatment of dysplastic Barrett’s esophagus in Spain

Abstract

Background and study aims: To assess the cost-effectiveness of introducing

National Institute for Health and Care Excellence (NICE) guidance on monitoring and management of Barrett’s oesophagus and stage I oesophageal adenocarcinoma

“…A cost–utility analysis also compared RFA with endoscopic surveillance over 15 years and showed that RFA was cost effective at a threshold of £20 000 per QALY gained. 68 …”

“…In addition to the clinical studies, four cost–utility analyses were identified. 68 76–78 They reported that at a threshold of £20 000 per QALY gained, EMR combined with RFA was cost effective versus endoscopic surveillance 77 ; EMR plus RFA plus surveillance, EMR plus APC plus surveillance and surgery were all cost effective versus no surveillance 78 ; RFA followed by endoscopic surveillance was cheaper and more effective than oesophagectomy 76 ; and RFA alone was cheaper and more effective than oesophagectomy. 68 …”

“…A cost-utility analysis also compared RFA with endoscopic surveillance over 15 years and showed that RFA was cost effective at a threshold of £20 000 per QALY gained. 68 Based on their clinical experience and inclusion criteria for available RCTs, the committee emphasised that for RFA to be offered, evidence of low-grade dysplasia from biopsy results from two separate endoscopies and confirmation of the diagnosis on both sets of biopsies by two gastrointestinal pathologists should be present. They noted this was in line with current practice where RFA takes place in specialist centres by endoscopists with appropriate experience and would not be considered in cases where there is evidence of low-grade oesophageal dysplasia from biopsy results from only one endoscopy or where there is no confirmation by a second gastrointestinal pathologist.…”

“…68 76-78 They reported that at a threshold of £20 000 per QALY gained, EMR combined with RFA was cost effective versus endoscopic surveillance 77 ; EMR plus RFA plus surveillance, EMR plus APC plus surveillance and surgery were all cost effective versus no surveillance 78 ; RFA followed by endoscopic surveillance was cheaper and more effective than oesophagectomy 76 ; and RFA alone was cheaper and more effective than oesophagectomy. 68 Based on clinical experience the committee recommended that high-grade dysplasia should be endoscopically resected, when oesophageal lesions are visible at endoscopy, and the residual Barrett's oesophagus should be treated with endoscopic ablation.…”