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01-08-2012 | Original Article

Modeling the Cost-effectiveness of Strategies for Treating Esophageal Adenocarcinoma and High-grade Dysplasia

Authors: Louisa G. Gordon, Nicholas G. Hirst, George C. Mayne, David I. Watson, Timothy Bright, Wang Cai, Andrew P. Barbour, Bernard M. Smithers, David C. Whiteman, Simon Eckermann, Australian Cancer Study Clinical Follow-Up Study

Published in: Journal of Gastrointestinal Surgery | Issue 8/2012

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.

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Moen, J., Antonov, K., Larsson, C.A., Lindblad, U., Nilsson, J.L.G., Råstam, L., Ring, L.: Factors Associated with Multiple Medication Use in Different Age Groups. Pharmacoepidemiology 43(12), 1978–1985 (2009).

Moss, A., Bourke, M.J., Hourigan, L.F., Gupta, S., Williams, S.J., Tran, K., Swan, M.P., Hopper, A.D., Kwan, V., Bailey, A.A.: Endoscopic Resection for Barrett’s High-Grade Dysplasia and Early Esophageal Adenocarcinoma: An Essential Staging Procedure With Long-Term Therapeutic Benefit. American Journal of Gastroenterology 2010, 23.

Shaheen, N., Sharma, P., Overholt, B.F., Wolfsen, H.C., Sampliner, R., Wang, G., Galanko, J.A., Bronner, M.P., Goldblum, J., Bennett, A.E.: Radiofrequency Ablation in Barrett’s Esophagus with Dysplasia. New England Journal of Medicine 360(22), 2277–2288 (2009).PubMedCrossRef

Wolfsen, H.C.: New technologies for imaging of Barrett’s esophagus. Surgical Oncology Clinics of North America 18(3), 487–502 (2009).PubMedCrossRef

Hirst, N.G., Gordon, L.G., Whiteman, D.C., Watson, D.I., Barendregt, J.J.: Is endoscopic surveillance for non-dysplastic Barrett’s esophagus cost-effective? Review of economic evaluations. J Gastroenterol Hepatol 26(2), 247–254 (2011). doi:10.1111/j.1440-1746.2010.06506.x PubMedCrossRef

Gordon, L.G., Eckermann, S., Hirst, N.G., Watson, D.I., Mayne, G.C., Fahey, P., Whiteman, D.C.: Healthcare resource use and medical costs for the management of oesophageal cancer. Br J Surg 98(11), 1589–1598 (2011).

Briggs, A., Claxton, K., Sculpher, M.: Decision Modelling for Health Economic Evaluation. Oxford University Press, Oxford (2006)

Smithers, B.M., Fahey, P.P., Corish, T., Gotley, D.C., Falk, G.L., Smith, G.S., Kiroff, G.K., Clouston, A.D., Watson, D.I., Whiteman, D.C.: Symptoms, investigations and management of patients with cancer of the oesophagus and gastro-oesophageal junction in Australia. Med J Aust 193(10), 572–577 (2010).PubMed

Eckermann, S., Coory, M., Willan, A.R.: Consistently estimating absolute risk difference when translating evidence to jurisdictions of interest. Pharmacoeconomics 29(2), 87–96 (2011).PubMedCrossRef

10.

Briggs, A., Gray, A.: The distribution of health care costs and their statistical analysis for economic evaluation. J Health Serv Res Policy 3(4), 233–245 (1998).PubMed

11.

AIHW: Cancer incidence data cubes. http://www.aihw.gov.au/cancer/data/datacubes/index.cfm (2009). Accessed 23 May 2009

12.

de Boer, A.G., Stalmeier, P.F., Sprangers, M.A., de Haes, J.C., van Sandick, J.W., Hulscher, J.B., van Lanschot, J.J.: Transhiatal vs extended transthoracic resection in oesophageal carcinoma: patients’ utilities and treatment preferences. British Journal of Cancer 86(6), 851–857 (2002).PubMedCrossRef

13.

Garside, R., Pitt, M., Somerville, M., Stein, K., Price, A., Gilbert, N.: Surveillance of Barrett’s oesophagus: exploring the uncertainty through systematic review, expert workshop and economic modelling. Health Technol Assess 10(8), 1–158 (2006).PubMed

14.

Gerson, L.B., Ullah, N., Hastie, T., Goldstein, M.K.: Does cancer risk affect health-related quality of life in patients with Barrett’s esophagus? Gastrointest Endosc 65(1), 16–25 (2007).PubMedCrossRef

15.

Hur, C., Nishioka, N.S., Gazelle, G.S.: Cost-effectiveness of aspirin chemoprevention for Barrett’s esophagus. J Natl Cancer Inst 96(4), 316–325 (2004).PubMedCrossRef

16.

OECD Statistics: Statistics: Purchasing Power Parities and exchange rates. http://stats.oecd.org/Index.aspx?datasetcode=SNA_TABLE4 (2011). Accessed 14 November 2011

17.

Stinnett, A.A., Mullahy, J.: Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Med. Decis. Making 18(2 Suppl), S68-80 (1998).PubMedCrossRef

18.

Eckermann, S., Karnon, J., Willan, A.R.: The value of value of information: best informing research design and prioritization using current methods. Pharmacoeconomics 28(9), 699–709 (2010).PubMedCrossRef

19.

Hoomans, T., Fenwick, E.A., Palmer, S., Claxton, K.: Value of information and value of implementation: application of an analytic framework to inform resource allocation decisions in metastatic hormone-refractory prostate cancer. Value Health 12(2), 315–324 (2009).PubMedCrossRef

20.

Willan, A.R., Eckermann, S.: Optimal clinical trial design using value of information methods with imperfect implementation. Health Econ. 19(5), 549–561 (2010).PubMed

21.

Eckermann, S., Briggs, A., Willan, A.R.: Health technology assessment in the cost-disutility plane. Med. Decis. Making 28(2), 172–181 (2008).PubMedCrossRef

22.

Shih, Y.C., Halpern, M.T.: Economic evaluations of medical care interventions for cancer patients: how, why, and what does it mean? CA Cancer J Clin 58(4), 231–244 (2008).PubMedCrossRef

23.

Boger, P.C., Turner, D., Roderick, P., Patel, P.: A UK-based cost-utility analysis of radiofrequency ablation or oesophagectomy for the management of high-grade dysplasia in Barrett’s oesophagus. Aliment Pharmacol Ther 32(11–12), 1332–1342 (2010).PubMedCrossRef

24.

Pohl, H., Sonnenberg, A., Strobel, S., Eckardt, A., Rosch, T.: Endoscopic versus surgical therapy for early cancer in Barrett’s esophagus: a decision analysis. Gastrointest Endosc 70(4), 623–631 (2009).PubMedCrossRef

25.

Jamieson, G.G., Mathew, G., Ludemann, R., Wayman, J., Myers, J.C., Devitt, P.G.: Postoperative mortality following oesophagectomy and problems in reporting its rate. Br J Surg 91(8), 943–947 (2004).PubMedCrossRef

26.

Metzger, R., Bollschweiler, E., Vallbohmer, D., Maish, M., DeMeester, T.R., Holscher, A.H.: High volume centers for esophagectomy: what is the number needed to achieve low postoperative mortality? Dis Esophagus 17(4), 310–314 (2004).PubMedCrossRef

27.

Funk, L.M., Gawande, A.A., Semel, M.E., Lipsitz, S.R., Berry, W.R., Zinner, M.J., Jha, A.K.: Esophagectomy outcomes at low-volume hospitals: the association between systems characteristics and mortality. Ann Surg 253(5), 912–917 (2011).PubMedCrossRef

28.

Zingg, U., Smithers, B.M., Gotley, D.C., Smith, G., Aly, A., Clough, A., Esterman, A.J., Jamieson, G.G., Watson, D.I.: Factors associated with postoperative pulmonary morbidity after esophagectomy for cancer. Ann Surg Oncol 18(5), 1460–1468 (2011).PubMedCrossRef

29.

Menon, D., Stafinski, T., Wu, H., Lau, D., Wong, C.: Endoscopic treatments for Barrett’s esophagus: a systematic review of safety and effectiveness compared to esophagectomy. BMC Gastroenterol 10(111), 111 (2010).PubMedCrossRef

30.

Bright, T., Watson, D.I., Tam, W., Game, P.A., Ackroyd, R., Devitt, P.G., Schoeman, M.N.: Prospective randomized trial of argon plasma coagulation ablation versus endoscopic surveillance of Barrett’s esophagus in patients treated with antisecretory medication. Dig Dis Sci 54(12), 2606–2611 (2009). doi:10.1007/s10620-008-0662-7 PubMedCrossRef

31.

Dijckmeester, W.A., Wijnhoven, B.P., Watson, D.I., Leong, M.P., Michael, M.Z., Mayne, G.C., Bright, T., Astill, D., Hussey, D.J.: MicroRNA-143 and −205 expression in neosquamous esophageal epithelium following Argon plasma ablation of Barrett’s esophagus. J Gastrointest Surg 13(5), 846–853 (2009). doi:10.1007/s11605-009-0799-5 PubMedCrossRef

32.

Inadomi, J.M., Sampliner, R., Lagergren, J., Lieberman, D., Fendrick, A.M., Vakil, N.: Screening and surveillance for Barrett esophagus in high-risk groups: a cost-utility analysis. Annals of Internal Medicine 138(3), 176–186 (2003).PubMed

33.

Inadomi, J.M., Somsouk, M., Madanick, R.D., Thomas, J.P., Shaheen, N.J.: A Cost-Utility Analysis of Ablative Therapy for Barrett’s Esophagus. Gastroenterology 136(7), 2101–2114 (2009).PubMedCrossRef

34.

Peters, F.P., Brakenhoff, K.P., Curvers, W.L., Rosmolen, W.D., Fockens, P., ten Kate, F.J., Krishnadath, K.K., Bergman, J.J.: Histologic evaluation of resection specimens obtained at 293 endoscopic resections in Barrett’s esophagus. Gastrointest Endosc 67(4), 604–609 (2008). doi:10.1016/j.gie.2007.08.039

35.

Peters, F.P., Kara, M.A., Rosmolen, W.D., Aalders, M.C., Ten Kate, F.J., Bultje, B.C., Krishnadath, K.K., Fockens, P., van Lanschot, J.J., van Deventer, S.J., Bergman, J.J.: Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett’s esophagus. Gastrointest Endosc 61(4), 506–514 (2005).

36.

Gerson, L.B., Groeneveld, P.W., Triadafilopoulos, G.: Cost-effectiveness model of endoscopic screening and surveillance in patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2(10), 868–879 (2004).PubMedCrossRef

37.

Stavrou, E.P., McElroy, H.J., Baker, D.F., Smith, G., Bishop, J.F.: Adenocarcinoma of the oesophagus: incidence and survival rates in New South Wales, 1972–2005. Medical Journal of Australia 191(6), 310–314 (2009).PubMed

38.

van Heijl, M., Omloo, J.M., van Berge Henegouwen, M.I., Hoekstra, O.S., Boellaard, R., Bossuyt, P.M., Busch, O.R., Tilanus, H.W., Hulshof, M.C., van der Gaast, A., Nieuwenhuijzen, G.A., Bonenkamp, H.J., Plukker, J.T., Cuesta, M.A., Ten Kate, F.J., Pruim, J., van Dekken, H., Bergman, J.J., Sloof, G.W., van Lanschot, J.J.: Fluorodeoxyglucose positron emission tomography for evaluating early response during neoadjuvant chemoradiotherapy in patients with potentially curable esophageal cancer. Ann Surg 253(1), 56–63 (2011).PubMedCrossRef

Title: Modeling the Cost-effectiveness of Strategies for Treating Esophageal Adenocarcinoma and High-grade Dysplasia
Authors: Louisa G. Gordon
Nicholas G. Hirst
George C. Mayne
David I. Watson
Timothy Bright
Wang Cai
Andrew P. Barbour
Bernard M. Smithers
David C. Whiteman
Simon Eckermann
Australian Cancer Study Clinical Follow-Up Study
Publication date: 01-08-2012
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 8/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-1911-9

At a glance: The STEP trials

Springer Medicine

Modeling the Cost-effectiveness of Strategies for Treating Esophageal Adenocarcinoma and High-grade Dysplasia

Abstract

Objective

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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