Photodynamic Therapy for Barrett’s Esophagus with High-Grade Dysplasia: A Cost-Effectiveness Analysis

Author:

Comay Dan1,Blackhouse Gord23,Goeree Ron23,Armstrong David1,Marshall John K13

Affiliation:

1. Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada

2. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

3. Centre for Evaluation of Medicines (St Joseph’s Hospital), McMaster University, Hamilton, Ontario, Canada

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.

Funder

Axcan Pharma Inc, Canada

Publisher

Hindawi Limited

Subject

Gastroenterology,General Medicine

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