A UK-based cost-utility analysis of radiofrequency ablation or oesophagectomy for the management of high-grade dysplasia in Barrett's oesophagus.

Journal Article (Journal Article)

BACKGROUND: In the UK, oesophagectomy is the current recommendation for patients with persistent high-grade dysplasia in Barrett's oesophagus. Radiofrequency ablation is an alternative new technology with promising early trial results. AIM: To undertake a cost-utility analysis comparing these two strategies. METHODS: We constructed a Markov model to simulate the natural history of a cohort of patients with high-grade dysplasia in Barrett's oesophagus undergoing one of two treatment options: (i) oesophagectomy or (ii) radiofrequency ablation followed by endoscopic surveillance with oesophagectomy for high-grade dysplasia recurrence or persistence. RESULTS: In the base case analysis, radiofrequency ablation dominated as it generated 0.4 extra quality of life years at a cost saving of £1902. For oesophagectomy to be the most cost-effective option, it required a radiofrequency ablation treatment failure rate (high-grade dysplasia persistence or progression to cancer) of >44%, or an annual risk of high-grade dysplasia recurrence or progression to cancer in the ablated oesophagus of >15% per annum. There was an 85% probability that radiofrequency ablation remained cost-effective at the NICE willingness to pay threshold range of £20 000-30 000. CONCLUSION: Radiofrequency ablation is likely to be a cost-effective option for high-grade dysplasia in Barrett's oesophagus in the UK.

Full Text

Duke Authors

Cited Authors

  • Boger, PC; Turner, D; Roderick, P; Patel, P

Published Date

  • December 2010

Published In

Volume / Issue

  • 32 / 11-12

Start / End Page

  • 1332 - 1342

PubMed ID

  • 21050235

Electronic International Standard Serial Number (EISSN)

  • 1365-2036

Digital Object Identifier (DOI)

  • 10.1111/j.1365-2036.2010.04450.x


  • eng

Conference Location

  • England