Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 23 June 2018

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Cost effectiveness of Barrett's esophagus management

A strategy of endoscopic ablation provided the longest quality adjusted life expectancy for Barrett's esophagus with high grade dysplasia, finds a report in December's issue of Gut.

News image

fiogf49gjkf04

Multiple treatment strategies for subjects with high grade dysplasia (HGD) in Barrett’s esophagus (BO) have been suggested.

However, it is unclear which of these strategies provides the greatest life expectancy, and the costs associated with the management strategies are unknown.

Dr Shaheen and colleagues from America undertook a study to compare the efficacy and cost effectiveness of competing management strategies for BO with HGD.

The researchers created a decision analysis model in Data 4.0 to assess possible treatment strategies for BO with HGD.

The strategies included: (1) no preventative strategy, (2) elective surgical esophagectomy, (3) endoscopic ablation, and (4) surveillance endoscopy.

The researchers decided on a base case that was a healthy 50 year old White male with an initial diagnosis of BO with HGD.

The model allowed for complications of surgery, including death. Ablative therapy could cause stricture or perforation.

Pathological misinterpretation was allowed, and modeled after reported rates.

Endoscopic ablation was the most effective strategy, yielding 15.5 discounted quality adjusted life years
Gut

The research team derived estimates from the literature for the rate of progression of HGD to cancer and for complication rates for the various treatment modalities.

The endoscopic ablation arm was modeled as photodynamic therapy.

The researchers carried out sensitivity analyses over a wide range of cancer incidences, complication rates, and procedure costs.

The research team found that endoscopic ablation was the most effective strategy, yielding 15.5 discounted quality adjusted life years (dQALY), compared with 15.0 for endoscopic surveillance and 14.9 for esophagectomy.

In addition, the researchers found that no preventative strategy was the most inexpensive option, yielding an average cost per quality adjusted life year of $54 (44) per dQALY, but resulted in high rates of cancer.

Endoscopic surveillance dominated esophagectomy, being both less costly and more effective.

Although the total costs of ablation were greater than those of surveillance, it was less expensive to buy an additional life year using endoscopic ablation than endoscopic surveillance.

The incremental cost effectiveness ratio when moving from no therapy to ablative therapy was a reasonable $25 621/dQALY.

Sensitivity analysis demonstrated that when yearly rates of progression to cancer from HGD exceeded 30%, esophagectomy became the most cost effective option.

Dr Shaheen concluded, "A strategy of endoscopic ablation provided the longest quality adjusted life expectancy for BO with HGD."

Dr Shaheen added, "Although endoscopic surveillance was less expensive than endoscopic ablation, it was associated with shorter survival."

"Optimal utilization of healthcare resources may be achieved with endoscopic ablative therapy for BO with HGD."

Gut; 2004: 53:1736-1744
15 November 2004

Go to top of page Email this page Email this page to a colleague

 31 May 2018 
Diagnostic for NAFLD  
 31 May 2018 
Bile acids and the risks for hepatotoxicity
 31 May 2018 
Rectal cancer female sexuality score
 30 May 2018 
Fungal dysbiosis in cirrhosis
 30 May 2018 
Placebo rates in ulcerative colitis trials
 30 May 2018 
Follow-up testing and colorectal cancer mortality
 29 May 2018 
Organ transplantation donors
 29 May 2018 
Novel therapies for IBD
 29 May 2018 
Helicobacter pylori infection to stomach cancer
 28 May 2018 
Mesalazine in ulcerative colitis
 28 May 2018 
Technology and management of digestive diseases
 28 May 2018 
Therapeutic strategies for HCV
 25 May 2018 
Post‐operative complications in elderly IBD
 25 May 2018 
Technology to increase colorectal cancer screening
 25 May 2018 
Colorectal cancer–specific mortality
 24 May 2018 
Alcohol consumption and outcomes in drug-induced liver injury
 24 May 2018 
Patient-reported outcome measures in IBD trials
 24 May 2018 
Precision medicine for tumors
 23 May 2018 
Management of perianal fistulas in Crohn’s disease
 23 May 2018 
Cardiovascular risk in diabetes mellitus with NAFLD
 23 May 2018 
High body mass index is and ulcerative colitis
 22 May 2018 
Worldwide H.pylori prevalence
 22 May 2018 
PPI and risk of stroke
 22 May 2018 
Online tool predicts bowel dysfunction severity prior to anterior resection
 21 May 2018 
PPI use and cognitive decline
 21 May 2018 
Depressive symptoms in IBD youth
 21 May 2018 
Fecal incontinence and quality of life in IBD
 18 May 2018 
Esophageal dilatation in clinical practice 
 17 May 2018 
IBD and later extraintestinal manifestations
 17 May 2018 
Repeat stool DNA testing
 17 May 2018 
IBS and chronic fatigue following GI infection
 16 May 2018 
Factors associated with fecal incontinence
 16 May 2018 
Diagnostic delay in Crohn's disease
 16 May 2018 
Cardiovascular risk in diabetes mellitus with NAFLD
 15 May 2018 
Guidelines for management of Crohn's
 15 May 2018 
New therapies for CDI
 15 May 2018 
Hep B in the Grey Zone
 14 May 2018 
Blood test for the diagnosis of fibrotic NASH
 14 May 2018 
Outcomes at bariatric centers of excellence
 14 May 2018 
Management of perianal fistulas in Crohn’s
 11 May 2018 
Detection of undiagnosed celiac disease
 11 May 2018 
Alcohol consumption and drug-induced liver injury
 10 May 2018 
Colorectal cancer screening
 10 May 2018 
Fibrosis in patients with chronic hepatitis B
 09 May 2018 
Fecal incontinence
 09 May 2018 
Health problems and IBS
 09 May 2018 
Esophageal dilatation in clinical practice 
 07 May 2018 
Health problems and IBS
 07 May 2018 
Assessment of diminutive colorectal polyps
 07 May 2018 
Omitting antibiotics in uncomplicated acute diverticulitis
 04 May 2018 
National Institutes of Health workshop and obesity
 04 May 2018 
Factors associated with fecal incontinence
 04 May 2018 
Colorectal cancer screening and ethnic inequities
 03 May 2018 
Gastrointestinal ultrasound in IBD
 03 May 2018 
Ultransonography in postsurgical recurrence in Crohn's
 02 May 2018 
Chronic Hep B
 02 May 2018 
Hep C antiviral treatment and liver cancer risk
 02 May 2018 
Symptom assessment in cirrhotic ascites
 01 May 2018 
Interferon‐free regimens in Hep C
 01 May 2018 
European guidelines on pancreatic cystic neoplasms

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2018 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us