Cost-effectiveness of photodynamic therapy for high-grade dysplasia in Barrett's esophagus

Journal Article

Photodynamic therapy appears to be effective in ablating high-grade dysplasia in Barrett's esophagus. Our aim was to identify the most effective and cost-effective strategy for managing high-grade dysplasia in Barrett's esophagus without associated endoscopically visible abnormalities. By using decision analysis, the lifetime costs and benefits of 4 strategies for which long-term data exist were estimated by us: esophagectomy, endoscopic surveillance, photodynamic therapy, followed by esophagectomy for residual high-grade dysplasia; and photodynamic therapy followed by endoscopic surveillance for residual high-grade dysplasia. It was assumed by us that there was a 30% prevalence of cancer in high-grade dysplasia patients and a 77% efficacy of photodynamic therapy for high-grade dysplasia and early cancer. Esophagectomy cost $24,045, with life expectancy of 11.82 quality-adjusted life years. In comparison, photodynamic therapy followed by surveillance for residual high-grade dysplasia was the most effective strategy, with a quality-adjusted life expectancy of 12.31 quality-adjusted life years, but it also incurred the greatest lifetime cost ($47,310) for an incremental cost-effectiveness of $47,410/quality-adjusted life years. The results were sensitive to post-surgical quality of life and survival, and to cancer prevalence if photodynamic therapy efficacy for cancer was less than 50%. Photodynamic therapy followed by endoscopic surveillance for residual high-grade dysplasia appears to be cost effective compared with esophagectomy for patients diagnosed with high-grade dysplasia in Barrett's esophagus. Clinical trials directly comparing these strategies are warranted.

Full Text

Duke Authors

Cited Authors

  • Vij, R; Triadafilopoulos, G; Owens, DK; Kunz, P; Sanders, GD

Published Date

  • 2004

Published In

Volume / Issue

  • 60 / 5

Start / End Page

  • 739 - 756

PubMed ID

  • 15557950

International Standard Serial Number (ISSN)

  • 0016-5107

Digital Object Identifier (DOI)

  • 10.1016/S0016-5107(04)02167-4