Achieving cost-effective endoscopic surveillance and treatment of Barrett’s oesophagus

Author: Ravi Vissapragada

Vissapragada, Ravi, 2023 Achieving cost-effective endoscopic surveillance and treatment of Barrett’s oesophagus, Flinders University, College of Medicine and Public Health

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Endoscopic surveillance for Barrett's oesophagus is not cost-effective, but the poor outcomes associated with advanced oesophageal adenocarcinoma have forced our hand. We used a decision-analytic Markov cohort model to identify cost-effective strategies for Barrett's oesophagus patients by reducing the frequency of surveillance for low-risk individuals stratified by gender and length of maximum visible Barrett's oesophagus segment and adding endoscopic ablation as a treatment. At a WTP threshold of AU$50,000/QALY, exclusion of short segment Barrett’s oesophagus (2 cm threshold) with 2-yearly endoscopy of long-segment subgroup was cost-effective in 90.3% of the simulations. Several other cost-effective strategies were also identified. The implications of this research are immediate, as clinical guidelines regarding frequency of endoscopic surveillance can be updated based on the most acceptable cost-effective strategy presented in this study. Additionally, endoscopic ablation of low-grade dysplasia must be given consideration as it was seen to be a dominating strategy across both risk-stratified and non-stratified cohorts.

Keywords: Health economics, cost-effectiveness, QALY, Barrett's oesophagus, oesophageal adenocarcinoma

Subject: Medical Science thesis

Thesis type: Doctor of Philosophy
Completed: 2023
School: College of Medicine and Public Health
Supervisor: Roger Yazbek