Year 2018 / Volume 110 / Number 3
Original
Economic evaluation of endoscopic radiofrequency ablation for the treatment of dysplastic Barrett’s esophagus in Spain

145-154

DOI: 10.17235/reed.2017.5087/2017

José Miguel Esteban, Pedro González-Carro, Joan B. Gornals, Carlos Collados, María Álvarez, Alejandro Pérez-Mitru, Suzan Serip,

Abstract
Background and study aims: To assess the cost-effectiveness of introducing endoscopic treatment based on radiofrequency ablation plus endoscopic mucosal resection in selected patients into the standard of care of Barrett’s esophagus patients with high-grade dysplasia or low-grade dysplasia in Spain. Methods: The disease evolution was modeled via a semi-Markov model. The treatment strategies compared included endoscopic treatment based on radiofrequency ablation plus endoscopic mucosal resection and the Standard of Care (esophagectomy or palliative chemoradiotherapy according to disease status for high-grade dysplasia and endoscopic surveillance for low-grade dysplasia). Efficacy rates, transition probabilities and utility values were obtained from the literature. Clinical management patterns and resource use were modeled according to Spanish clinical expert opinion. Costs were expressed in euros (€) from 2016 reflecting the Spanish National Health System perspective. Sensitivity analyses were performed to assess the robustness of the model. Results: With respect to the Spanish Standard of Care, endoscopic treatment based on radiofrequency ablation plus endoscopic mucosal resection was a dominant strategy for high-grade dysplasia patients. When a willingness-to-pay threshold of €30,000 per quality-adjusted life-years gained was considered, this was cost-effective for low-grade dysplasia patients (€12,865 per quality-adjusted life-years gained). The sensitivity analyses supported the base case analysis results and pointed towards the main drivers of uncertainty in the model. Conclusions: From a health care decision-maker, endoscopic treatment based on radiofrequency ablation plus endoscopic mucosal resection is the intervention of choice for dysplasic Barrett’s esophagus patients in Spain.
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References
1. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency Ablation in Barrett’s Esophagus with Dysplasia. N Engl J Med 2009; 360: 2277-88.
2. Bennett C, Moayyedi P, Corley DA, et al. BOB CAT Consistorium: A Large-Scale Review and Delphi Consensus for Management of Barrett’s Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia. Am J Gastroenterol 2015; 110: 662-82.
3. National Institute for Health and Care Excellence. Endoscopic radiofrequency ablation for Barrett's oesophagus with low-grade dysplasia or no dysplasia. 2014. Available from: https://www.nice.org.uk/guidance. Accessed 2016 May 30.
4. Fleischer DE, Overholt BF, Sharma VK, et al. Endoscopic ablation of Barrett’s esophagus: a multicenter study with 2.5-year follow-up. Gastrointest Endosc 2008; 68: 867-76.
5. Rees JR, Lao-Sirieix P, Wong A, et al. Treatment for Barrett's oesophagus. Cochrane Database Syst Rev 2010; (1): CD004060.
6. Tham T. Guidelines on the Diagnosis and Management of Barrett's Oesophagus - An Update. London: British Society of Gastroenterology 2015. Available from: http://www.bsg.org.uk/. Accessed 2016 Jun 16.
7. Spechler SJ, Sharma P, Souza RF, et al. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology 2011; 140: e18-52.
8. Hvid-Jensen F, Pedersen L, Drewes AM, et al. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 2011; 365: 1375-83.
9. Sikkema M, de Jonge PJF, Steyerberg EW, et al. Risk of esophageal adenocarcinoma and mortality in patients with Barrett’s esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2010; 8: 235-44.
10. Bennett C, Vakil N, Bergman J, et al. Consensus Statements for Management of Barrett’s Dysplasia and Early-Stage Esophageal Adenocarcinoma, Based on a Delphi Process. Gastroenterology 2012; 143: 336-46.
11. Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus (BSG). Gut 2014; 63: 7-42.
12. Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2017; 49 (2 Supl. 1-4): 191-8.
13. Darbà J, Kaskens L, Plans P, et al. Epidemiology and societal costs of gastroesophageal reflux disease and Barrett’s syndrome in Germany, Italy and Spain. Expert Rev Pharmacoecon Outcomes Res 2011; 11: 225-32.
14. Phoa KN, van Vilsteren FG, Weusten BL, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA 2014; 311: 1209-17.
15. Fleischer DE, Overholt BF, Sharma VK, et al. Endoscopic radiofrequency ablation for Barrett’s esophagus: 5-year outcomes from a prospective multicenter trial. Endoscopy 2010; 42: 781-9.
16. López Bastida J, Oliva J, Antoñanzas F, et al. [A proposed guideline for economic evaluation of health technologies]. Gac Sanit 2010; 24(2): 154-70.
17. National Statistics Institute. Life tables for the population of Spain by Year, Sex, Age and Function, 2014. Series 1975-2014. Available from: http://www.ine.es/en/. Accessed 2016 June 23.
18. Spanish Health Costs Database: eSalud. Barcelona: Oblikue Consulting, S.L. 2007. Available from: http://www.oblikue.com/bddcostes/. Accessed 2016 Jun 17.
19. General Council of the Association of Official Pharmacists. General Council of the Association of Official Pharmacists Database: Bot PLUS 2.0. Available from: https://botplusweb.portalfarma.com/. Accessed 2016 Jun 16.
20. Gerson LB. Cost-Analyses Studies in Barrett's Esophagus: What Is Their Utility? Gastroenterol Clin North Am 2015; 44: 425-38.
21. National Statistics Institute. National Health Survey. 2013. Available from: http://www.ine.es/en. Accessed 2016 Jun 17.
22. Sacristán JA, Oliva J, Del Llano J, et al. [What is an efficient health technology in Spain?]. Gac Sanit 2002; 16: 334-43.
23. Inadomi JM. Cost considerations in implementing a screening and surveillance strategy for Barrett's oesophagus. Best Pract Res Clin Gastroenterol 2015; 29: 51-63.
24. Gerson LB, Ullah N, Hastie T, et al. Does cancer risk affect health-related quality of life in patients with Barrett's esophagus? Gastrointest Endosc 2007; 65: 16-25.
25. National Institute for Health and Care Excellence. Epithelial radiofrequency ablation for Barrett's oesophagus. London: 2010. Available from: https://www.nice.org.uk/guidance/ipg344 Accessed 2016 Jun 13.
26. Centre for Clinical Practice at NICE. Barrett’s Oesophagus: Ablative Therapy for the Treatment of Barrett’s Oesophagus. Appendix 6, Cost effectiveness analysis for Barrett’s oesophagus. London: National Institute for Health and Clinical Excellence; 2010. Available from: http://www.ncbi.nlm.nih.gov/books/. Accessed 2016 Jul 1.
27. Hur C, Choi SE, Rubenstein JH, et al. The Cost-Effectiveness of Radiofrequency Ablation for Barrett’s Esophagus. Gastroenterology 2012; 143: 567-75.
28. Boger PC, Turner D, Roderick P, et al. A UK-based cost-utility analysis of radiofrequency ablation or oesophagectomy for the management of high-grade dysplasia in Barrett’s oesophagus. Aliment Pharmacol Ther 2010; 32: 1332-42.
29. Inadomi JM, Somsouk M, Madanick RD, et al. A cost-utility analysis of ablative therapy for Barrett's esophagus. Gastroenterology 2009; 136: 2101-14.
30. Orman ES, Li N, Shaheen NJ. Efficacy and durability of radiofrequency ablation for Barrett's Esophagus: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2013; 11: 1245-55.
31. Komeda Y, Bruno M, Koch A. EMR is not inferior to ESD for early Barrett’s and EGJ neoplasia: An extensive review on outcome, recurrence and complication rates. Endosc Int Open 2014; 2: 58-64.
32. Sánchez MC, Fernández L, Atienza G. [Radiofrequency ablation for Barrett´s esophagus with high-grade dysplasia or intramucosal cancer: a systematic review]. Informes de evaluación de tecnologías sanitarias; 2015. Available from: http://avalia-t.sergas.es/DXerais/305/avalia-t201502_RadiofrecuenciaBarret_DEF.pdf. Accessed 2016 Jun 23.
33. Phoa KN, Rosmolen WD, Weusten BL, et al. The cost-effectiveness of radiofrequency ablation for Barrett's Esophagus with low-grade dysplasia: Results from a randomized controlled trial (SURF-trial). Gastrointest Endosc 2017; 86(1):120-29.
34. Shaheen NJ, Falk GW, Iyer PG, et al. ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus. Am J Gastroenterol 2016; 111(1): 30-50.
35. Martín de Argila de Prados C, Aguilera Castro L, Rodríguez de Santiago E. PPIs: between overuse and underprescription when really necessary. Rev Esp Enferm Dig 2015; 107(11): 649-51.
36. Aguilera-Castro L, Martín-de-Argila-dePrados C, Albillos-Martínez A. Practical considerations in the management of proton-pump inhibitors. Rev Esp Enferm Dig 2016; 108(3):145-53.
37. Hu Y, Puri V, Shami VM, et al. Comparative Effectiveness of Esophagectomy Versus Endoscopic Treatment for Esophageal High-grade Dysplasia. Ann Surg 2016; 263: 719-26.
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Esteban J, González-Carro P, Gornals J, Collados C, Álvarez M, Pérez-Mitru A, et all. Economic evaluation of endoscopic radiofrequency ablation for the treatment of dysplastic Barrett’s esophagus in Spain. 5087/2017


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Publication history

Received: 29/05/2017

Accepted: 10/10/2017

Online First: 23/11/2017

Published: 28/02/2018

Article revision time: 124 days

Article Online First time: 178 days

Article editing time: 275 days


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