Photodynamic therapy for Barrett's esophagus with high-grade dysplasia: A cost-effectiveness analysis

被引:10
|
作者
Comay, Dan
Blackhouse, Gord
Goeree, Ron
Armstrong, David
Marshall, John K.
机构
[1] McMaster Univ, Med Ctr, Div Gastroenterol, Dept Med, Hamilton, ON L8N 3Z5, Canada
[2] McMaster Univ, St Josephs Hosp, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada
[3] McMaster Univ, St Josephs Hosp, Ctr Evaluat Med, Hamilton, ON L8N 3Z5, Canada
来源
CANADIAN JOURNAL OF GASTROENTEROLOGY | 2007年 / 21卷 / 04期
关键词
Barrett's esophagus; high-grade dysplasia; photodynamic therapy;
D O I
10.1155/2007/791062
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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 (HOD). 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. TI-ie time horizon for the model was five years (cycle length three months), and costs and outcornes 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 incre, mental 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 inale patients with BE and HGD, PDT and ESO are cost-effective alternatives to SURV.
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页码:217 / 222
页数:6
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