Modeling the cost-effectiveness of strategies for treating esophageal adenocarcinoma and high grade dysplasia

Journal Article


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Abstract


  • Objective This study aims to synthesize cost and health outcomes for current treatment pathways for esophageal adenocarcinoma and high-grade dysplasia (HGD) and to model comparative net clinical and economic benefits of alternative management scenarios.

    Methods A decision-analytic model of real-world practices for esophageal adenocarcinoma treatment by tumor stage was constructed and validated. The model synthesized treatment probabilities, survival, quality of life, and resource use extracted from epidemiological datasets, published literature, and expert opinion. Comparative analyses between current practice and

    five hypothetical scenarios for modified treatment were undertaken.

    Results Over 5 years, outcomes across T stage ranged from 4.06 quality-adjusted life-years and costs of $3,179 for HGD to 1.62 quality-adjusted life-years and costs of $50,226 for stage T4. Greater use of endoscopic mucosal resection for stage T1 and measures to reduce esophagectomy mortality to 0–3 % produced modest gains, whereas a 20 % reduction in the

    proportion of patients presenting at stage T3 produced large incremental net benefits of $4,971 (95 % interval, $1,560–8,368).

    Conclusion These findings support measures that promote earlier diagnosis, such as developing risk assessment processes or endoscopic surveillance of Barrett’s esophagus. Incremental net monetary benefits for other strategies are relatively small in comparison to predicted gains from early detection strategies.

Authors


  •   Gordon, Louisa G. (external author)
  •   Hirst, Nicholas G. (external author)
  •   Mayne, George (external author)
  •   Watson, David I. (external author)
  •   Bright, Timothy (external author)
  •   Cai, Wang (external author)
  •   Barbour, Andrew P. (external author)
  •   Smithers, Bernard M. (external author)
  •   Whiteman, David C. (external author)
  •   Eckermann, Simon

Publication Date


  • 2012

Citation


  • L. G. Gordon, N. G. Hirst, G. Mayne, D. Watson, T. Bright, W. Cai, A. P. Barbour, B. M. Smithers, D. C. Whiteman & S. Eckermann, "Modeling the cost-effectiveness of strategies for treating esophageal adenocarcinoma and high grade dysplasia", Journal of Gastrointestinal Surgery 16 8 (2012) 1451-1461.

Scopus Eid


  • 2-s2.0-84864082540

Ro Full-text Url


  • http://ro.uow.edu.au/cgi/viewcontent.cgi?article=1144&context=ahsri

Ro Metadata Url


  • http://ro.uow.edu.au/ahsri/140

Has Global Citation Frequency


Number Of Pages


  • 10

Start Page


  • 1451

End Page


  • 1461

Volume


  • 16

Issue


  • 8

Place Of Publication


  • United States

Abstract


  • Objective This study aims to synthesize cost and health outcomes for current treatment pathways for esophageal adenocarcinoma and high-grade dysplasia (HGD) and to model comparative net clinical and economic benefits of alternative management scenarios.

    Methods A decision-analytic model of real-world practices for esophageal adenocarcinoma treatment by tumor stage was constructed and validated. The model synthesized treatment probabilities, survival, quality of life, and resource use extracted from epidemiological datasets, published literature, and expert opinion. Comparative analyses between current practice and

    five hypothetical scenarios for modified treatment were undertaken.

    Results Over 5 years, outcomes across T stage ranged from 4.06 quality-adjusted life-years and costs of $3,179 for HGD to 1.62 quality-adjusted life-years and costs of $50,226 for stage T4. Greater use of endoscopic mucosal resection for stage T1 and measures to reduce esophagectomy mortality to 0–3 % produced modest gains, whereas a 20 % reduction in the

    proportion of patients presenting at stage T3 produced large incremental net benefits of $4,971 (95 % interval, $1,560–8,368).

    Conclusion These findings support measures that promote earlier diagnosis, such as developing risk assessment processes or endoscopic surveillance of Barrett’s esophagus. Incremental net monetary benefits for other strategies are relatively small in comparison to predicted gains from early detection strategies.

Authors


  •   Gordon, Louisa G. (external author)
  •   Hirst, Nicholas G. (external author)
  •   Mayne, George (external author)
  •   Watson, David I. (external author)
  •   Bright, Timothy (external author)
  •   Cai, Wang (external author)
  •   Barbour, Andrew P. (external author)
  •   Smithers, Bernard M. (external author)
  •   Whiteman, David C. (external author)
  •   Eckermann, Simon

Publication Date


  • 2012

Citation


  • L. G. Gordon, N. G. Hirst, G. Mayne, D. Watson, T. Bright, W. Cai, A. P. Barbour, B. M. Smithers, D. C. Whiteman & S. Eckermann, "Modeling the cost-effectiveness of strategies for treating esophageal adenocarcinoma and high grade dysplasia", Journal of Gastrointestinal Surgery 16 8 (2012) 1451-1461.

Scopus Eid


  • 2-s2.0-84864082540

Ro Full-text Url


  • http://ro.uow.edu.au/cgi/viewcontent.cgi?article=1144&context=ahsri

Ro Metadata Url


  • http://ro.uow.edu.au/ahsri/140

Has Global Citation Frequency


Number Of Pages


  • 10

Start Page


  • 1451

End Page


  • 1461

Volume


  • 16

Issue


  • 8

Place Of Publication


  • United States