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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

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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Acknowledgments

L. Gordon is supported by a National Health and Medical Research Council Early Career Fellowship #496714.

Author information

Authors and Affiliations

  1. Centre for Applied Health Economics, Griffith Health Institute, Griffith University, Logan Campus, University Drive, Meadowbrook, Queensland, 4131, Australia

    Louisa G. Gordon & Nicholas G. Hirst

  2. Population Health Department, Queensland Institute of Medical Research, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland, 4029, Australia

    Louisa G. Gordon & David C. Whiteman

  3. Department of Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, 5042, Australia

    George C. Mayne, David I. Watson, Timothy Bright & Wang Cai

  4. Upper Gastrointestinal and Soft Tissue Unit, Division of Surgery, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia

    Andrew P. Barbour & Bernard M. Smithers

  5. Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia

    Simon Eckermann

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  1. Louisa G. Gordon
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Australian Cancer Study Clinical Follow-Up Study

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Correspondence to Louisa G. Gordon.

Appendices

Appendix 1

Database: PubMED, MEDLINE

Literature search terms for model probabilities

For EMR (split between T1m T1sm) data:

(esophagus OR oesophagus) AND dysplasia AND (T1a OR T1s OR T1b or T1sm)

8 results. References from selected papers to be searched.

For ablation findings:

(esophagus OR oesophagus) AND (radiofrequency OR RFA) AND ablation AND (dysplasia OR HGD)

24 results. References from selected papers to be searched.

For surgical and endoscopic therapy survival or other data:

(esophagus OR oesophagus) AND (T1a OR T1s OR T1b or T1sm) AND (survival OR mortality)

12 results. References from selected papers to be searched.

Appendix 2

Method to elicit expert opinion for some data estimates

Independent interviews were undertaken between authors LG and NG and five esophageal surgeons. The interviews were designed to ask the same set of questions where gaps existed in the literature. Responses were recorded and the range of all responses collated. Consensus was reached via e-mail correspondence after the surgeons were given the opportunity to agree/disagree with the group range. An average was taken of each estimate for the baseline model and range included in the sensitivity analyses. The surgeons were chosen from high-volume centers and with an active interest in esophageal cancer research. The locations spanned two Australian states and surgeons worked in private and public hospital settings.

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Gordon, L.G., Hirst, N.G., Mayne, G.C. et al. Modeling the Cost-effectiveness of Strategies for Treating Esophageal Adenocarcinoma and High-grade Dysplasia. J Gastrointest Surg 16, 1451–1461 (2012). https://doi.org/10.1007/s11605-012-1911-9

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