Endoscopic radiofrequency ablation for Barrett’s esophagus: 5-year outcomes from a prospective multicenter trial

Fleischer, David E.; Overholt, Bergein F.; Sharma, Virender K.; Reymunde, Alvaro; Kimmey, Michael B.; Chuttani, Ram; Chang, Karen; Muthasamy, R.; Lightdale, Charles J.; Santiago, Nilda; Pleskow, Douglas K.; Dean, Philip A. W.; Wang, K. K.

doi:10.1055/s-0030-1255779

Cited by 208 publications

(152 citation statements)

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“…An increasing number of publications on the long-term efficacy show that radiofrequency ablation is durable in more than 90% of patients during follow-up. 6,18 The cost-effectiveness of ablation may therefore improve for a longer observation period if patients undergo follow-up endoscopies at a lower intensity after successful ablation compared with untreated patients. In opposition, any recurrence in the ablation arm after treatment could increase the costs for ablation, as re-treatment may be required.…”

Section: Discussionmentioning

confidence: 99%

The cost-effectiveness of radiofrequency ablation for Barrett's esophagus with low-grade dysplasia: results from a randomized controlled trial (SURF trial)

Phoa

Rosmolen

Weusten

et al. 2017

Gastrointestinal Endoscopy

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Background and Aims: The Surveillance versus Radiofrequency Ablation (SURF) trial randomized 136 patients with Barrett's esophagus (BE) containing low-grade dysplasia (LGD), to receive radiofrequency ablation (ablation, n Z 68) or endoscopic surveillance (control, n Z 68). Ablation reduced the risk of neoplastic progression to highgrade dysplasia and esophageal adenocarcinoma (EAC) by 25% over 3 years (1.5% for ablation vs 26.5% for control). We performed a cost-effectiveness analysis from a provider perspective alongside this trial.Methods: Patients were followed for 3 years to quantify their use of health care services, including therapeutic and surveillance endoscopies, treatment of adverse events, and medication. Costs for treatment of progression were analyzed separately. Incremental cost-effectiveness ratios (ICER) were calculated by dividing the difference in costs (excluding and including the downstream costs for treatment of progression) by the difference in prevented events of progression. Bootstrap analysis (1000 samples) was used to construct 95% confidence intervals (CIs).Results: Patients who underwent ablation generated mean costs of U.S.$13,503 during the trial versus $2236 for controls (difference $11,267; 95% CI, $9996-$12,378), with an ICER per prevented event of progression of $45,066. Including the costs for treatment of progression, ablation patients generated mean costs of $13,523 versus $4,930 for controls (difference $8593; 95% CI, $6881-$10,153) with an ICER of $34,373. Based on the various ICER estimates derived from the bootstrap analysis, one can be reasonably certain (>75%) that ablation is efficient at a willingness to pay of $51,664 per prevented event of progression or $40,915 including downstream costs of progression.Conclusions: Ablation for patients with confirmed BE-LGD is more effective and more expensive than endoscopic surveillance in reducing the risk of progression to high-grade dysplasia/EAC. The increase in costs of ablation can be justified to avoid a serious event such as neoplastic progression. At a willingness to pay of $40,915 per prevented event of progression, one can be reasonably certain that ablation is efficient. (www.trialregister.nl number: NTR 1198.) (Gastrointest Endosc 2017;-:1-10.)

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Section: Discussionmentioning

confidence: 99%

The cost-effectiveness of radiofrequency ablation for Barrett's esophagus with low-grade dysplasia: results from a randomized controlled trial (SURF trial)

Phoa

Rosmolen

Weusten

et al. 2017

Gastrointestinal Endoscopy

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“…Although ablative therapy followed by endoscopic surveillance has been reported to reduce the recurrence of IM (1,15), there is no controversy in this regard (30).…”

Section: Discussionmentioning

confidence: 99%

“…According to the evidence published in the main clinical trials that have evaluated RFA, the mean age of the two cohorts was set at 65 years (range 55-75 years) (1,14,15).…”

Section: Patientsmentioning

confidence: 99%

Economic evaluation of endoscopic radiofrequency ablation for the treatment of dysplastic Barretts esophagus in Spain

et al. 2017

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“…The available data from prospective trials are summarized in Table III (123,(145)(146)(147)(148)(149)(150)(151)(152)(153)(154)(155)(156).…”

Section: Radiofrequency Ablation (Rfa)mentioning

confidence: 99%

Endoscopic diagnosis and therapies for Barrett esophagus: a review

Waxman

González-Haba-Ruiz

Vázquez-Sequeiros

2014

Rev. esp. enferm. dig.

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Endoscopic radiofrequency ablation for Barrett’s esophagus: 5-year outcomes from a prospective multicenter trial

Abstract: In patients with NDBE treated with RFA, CR-IM was demonstrated in the majority of patients (92 %) at 5-year follow-up, biopsy depth was adequate to detect recurrence, and all failures (4 / 4, 100 %) were converted to CR-IM with single-session focal RFA.

Cited by 208 publications

References 48 publications

The cost-effectiveness of radiofrequency ablation for Barrett's esophagus with low-grade dysplasia: results from a randomized controlled trial (SURF trial)

The cost-effectiveness of radiofrequency ablation for Barrett's esophagus with low-grade dysplasia: results from a randomized controlled trial (SURF trial)

Economic evaluation of endoscopic radiofrequency ablation for the treatment of dysplastic Barretts esophagus in Spain

Endoscopic diagnosis and therapies for Barrett esophagus: a review

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Endoscopic radiofrequency ablation for Barrett’s esophagus: 5-year outcomes from a prospective multicenter trial

Abstract: In patients with NDBE treated with RFA, CR-IM was demonstrated in the majority of patients (92 %) at 5-year follow-up, biopsy depth was adequate to detect recurrence, and all failures (4 / 4, 100 %) were converted to CR-IM with single-session focal RFA.

Cited by 208 publications

References 48 publications

The cost-effectiveness of radiofrequency ablation for Barrett's esophagus with low-grade dysplasia: results from a randomized controlled trial (SURF trial)

The cost-effectiveness of radiofrequency ablation for Barrett's esophagus with low-grade dysplasia: results from a randomized controlled trial (SURF trial)

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

Endoscopic diagnosis and therapies for Barrett esophagus: a review

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Economic evaluation of endoscopic radiofrequency ablation for the treatment of dysplastic Barretts esophagus in Spain