Photodynamic Therapy for Barrett's Esophagus with High-Grade Dysplasia: A Cost-Effectiveness Analysis. (2007)

• Record Type: Journal Article
• Authors: Comay, Dan; Blackhouse, Gord; Goeree, Ron; Armstrong, David; Marshall, John K
• Is Part Of: Canadian Journal of Gastroenterology. Volume 21:Number 4(2007)
• Page Start: 217
• Page End: 222
• Publication Date: 2007
• Subjects: Barrett's esophagus -- High-grade dysplasia -- Photodynamic therapy
• DOI: 10.1155/2007/791062
• Languages: English
• ISSNs: 0835-7900

Abstract

Abstract : OBJECTIVES: To assess the cost-effectiveness of photodynamic therapy (PDT) and esophagectomy (ESO) relative to surveillance (SURV) for patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD). METHODS: A Markov decision tree was constructed to estimate costs and health outcomes of PDT, ESO and SURV in a hypothetical cohort of male patients, 50 years of age, with BE and HGD. Outcomes included unadjusted life-years (LYs) and quality-adjusted LYs (QALYs). Direct medical costs (2003 CDN$) were measured from the perspective of a provincial ministry of health. The time horizon for the model was five years (cycle length three months), and costs and outcomes were discounted at 3%. Model parameters were assigned unique distributions, and a probabilistic analysis with 10, 000 Monte Carlo simulations was performed. RESULTS: SURV was the least costly strategy, followed by PDT and ESO, but SURV was also the least effective. In terms of LYs, the incremental cost-effectiveness ratios were $814/LY for PDT versus SURV and $3, 397/LY for ESO versus PDT. PDT dominated ESO for QALYs in the base-case. The incremental cost-effectiveness ratio of PDT versus SURV was $879/QALY. In probabilistic analysis, PDT was most likely to be cost-effective at willingness-to-pay (WTP) values between $100/LY and $3, 500/LY, and ESO was most likely to be cost-effective for WTP values over $3500/LY. For quality-adjusted survival, PDT was most likely to be cost-effective for all WTP thresholds above $1, 000/QALY. The likelihood that PDT was the most cost-effective strategy reached 0.99 at a WTP ceiling of $25, 000/QALY. CONCLUSIONS: In male patients with BE and HGD, PDT and ESO are cost-effective alternatives to SURV.