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

Louisa Gordon, Nicholas Hirst, George Mayne, David Watson, Tim Bright, Cai Wang, Andrew Barbour, Bernard Smithers, David Whiteman, Simon Eckermann

    Research output: Contribution to journalArticlepeer-review

    10 Citations (Scopus)


    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.

    Original languageEnglish
    Pages (from-to)1451-1461
    Number of pages11
    JournalJournal of Gastrointestinal Surgery
    Issue number8
    Publication statusPublished - Aug 2012


    • Adenocarcinoma of the esophagus
    • Cost-effectiveness
    • Decision-analytic model
    • Endoscopic mucosal resection


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