Gastroenterology
Volume 136, Issue 7 , Pages 2101-2114.e6 , June 2009

A Cost-Utility Analysis of Ablative Therapy for Barrett's Esophagus

  • John M. Inadomi

      Affiliations

    • Division of Gastroenterology, San Francisco General Hospital, San Francisco, California
    • GI Health Outcomes, Policy and Economics (HOPE) Research Program, Department of Medicine, University of California, San Francisco, San Francisco, California
    • Corresponding Author InformationReprint requests John M. Inadomi, MD, San Francisco General Hospital, Room 3D-5, 1001 Potrero Avenue, San Francisco, California 94110. fax: (415) 641-0745
    • ,
  • Ma Somsouk

      Affiliations

    • Division of Gastroenterology, San Francisco General Hospital, San Francisco, California
    • GI Health Outcomes, Policy and Economics (HOPE) Research Program, Department of Medicine, University of California, San Francisco, San Francisco, California
    • ,
  • Ryan D. Madanick

      Affiliations

    • Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
    • ,
  • Jennifer P. Thomas

      Affiliations

    • GI Health Outcomes, Policy and Economics (HOPE) Research Program, Department of Medicine, University of California, San Francisco, San Francisco, California
    • ,
  • Nicholas J. Shaheen

      Affiliations

    • Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina

Received 13 June 2008 ,Accepted 20 February 2009.

References 

  1. Lieberman DA, Oehlke M, Helfand M. Risk factors for Barrett's esophagus in community-based practice (GORGE consortium. Gastroenterology Outcomes Research Group in Endoscopy). Am J Gastroenterol. 1997;92:1293–1297
  2. Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103:788–797
  3. Wang KK, Wongkeesong M, Buttar NS. American Gastroenterological Association technical review on the role of the gastroenterologist in the management of esophageal carcinoma. Gastroenterology. 2005;128:1471–1505
  4. Wang KK, Wongkeesong M, Buttar NS. American Gastroenterological Association medical position statement: role of the gastroenterologist in the management of esophageal carcinoma. Gastroenterology. 2005;128:1468–1470
  5. Shaheen NJ. Advances in Barrett's esophagus and esophageal adenocarcinoma. Gastroenterology. 2005;128:1554–1566
  6. Reed MF, Tolis G, Edil BH, et al. Surgical treatment of esophageal high-grade dysplasia. Ann Thorac Surg. 2005;79:1110–1115
  7. Spechler SJ. Dysplasia in Barrett's esophagus: limitations of current management strategies. Am J Gastroenterol. 2005;100:927–935
  8. Overholt BF, Wang KK, Burdick JS, et al. Five-year efficacy and safety of photodynamic therapy with Photofrin in Barrett's high-grade dysplasia. Gastrointest Endosc. 2007;66:460–468
  9. Pech O, Gossner L, May A, et al. Long-term results of photodynamic therapy with 5-aminolevulinic acid for superficial Barrett's cancer and high-grade intraepithelial neoplasia. Gastrointest Endosc. 2005;62:24–30
  10. Hage M, Siersema PD, van Dekken H, et al. 5-aminolevulinic acid photodynamic therapy versus argon plasma coagulation for ablation of Barrett's oesophagus: a randomised trial. Gut. 2004;53:785–790
  11. Sharma P, Wani S, Weston AP, et al. A randomised controlled trial of ablation of Barrett's oesophagus with multipolar electrocoagulation versus argon plasma coagulation in combination with acid suppression: long term results. Gut. 2006;55:1233–1239
  12. Sharma VK, Wang KK, Overholt BF, et al. Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett's esophagus: 1-year follow-up of 100 patients. Gastrointest Endosc. 2007;65:185–195
  13. Seewald S, Ang TL, Soehendra N. Endoscopic mucosal resection of Barrett's oesophagus containing dysplasia or intramucosal cancer. Postgrad Med J. 2007;83:367–372
  14. Hubbard N, Velanovich V. Endoscopic endoluminal radiofrequency ablation of Barrett's esophagus in patients with fundoplications. Surg Endosc. 2007;21:625–628
  15. Gold MR, Siegel JE, Russell LB. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996;
  16. Beck JR, Pauker SG. The Markov process in medical prognosis. Med Decis Making. 1983;3:419–458
  17. Hage M, Siersema PD, van Dekken H, et al. Oesophageal cancer incidence and mortality in patients with long-segment Barrett's oesophagus after a mean follow-up of 12.7 years. Scand J Gastroenterol. 2004;39:1175–1179
  18. Guardino JM, Khandwala F, Lopez R, et al. Barrett's esophagus at a tertiary care center: association of age on incidence and prevalence of dysplasia and adenocarcinoma. Am J Gastroenterol. 2006;101:2187–2193
  19. Sharma P, Falk GW, Weston AP, et al. Dysplasia and cancer in a large multicenter cohort of patients with Barrett's esophagus. Clin Gastroenterol Hepatol. 2006;4:566–572
  20. Srivastava A, Hornick JL, Li X, et al. Extent of low-grade dysplasia is a risk factor for the development of esophageal adenocarcinoma in Barrett's esophagus. Am J Gastroenterol. 2007;102:483–493
  21. Provenzale D, Schmitt C, Wong JB. Barrett's esophagus: a new look at surveillance based on emerging estimates of cancer risk. Am J Gastroenterol. 1999;94:2043–2053
  22. Provenzale D, Kemp JA, Arora S, et al. A guide for surveillance of patients with Barrett's esophagus. Am J Gastroenterol. 1994;89:670–680
  23. Fisher D, Jeffreys A, Bosworth H, et al. Quality of life in patients with Barrett's esophagus undergoing surveillance. Am J Gastroenterol. 2002;97:2193–2200
  24. Gerson LB, Ullah N, Hastie T, et al. Patient-derived health state utilities for gastroesophageal reflux disease. Am J Gastroenterol. 2005;100:524–533
  25. Reid BJ, Haggitt RC, Rubin CE, et al. Observer variation in the diagnosis of dysplasia in Barrett's esophagus. Hum Pathol. 1988;19:166–178
  26. Alikhan M, Rex D, Khan A, et al. Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice. Gastrointest Endosc. 1999;50:23–26
  27. Sagan C, Flejou JF, Diebold MD, et al. Reproducibility of histological criteria of dysplasia in Barrett mucosa. Gastroenterol Clin Biol. 1994;18:D31–D34
  28. Montgomery E, Bronner MP, Goldblum JR, et al. Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation. Hum Pathol. 2001;32:368–378
  29. Reid BJ, Levine DS, Longton G, et al. Predictors of progression to cancer in Barrett's esophagus: baseline histology and flow cytometry identify low- and high-risk patient subsets. Am J Gastroenterol. 2000;95:1669–1676
  30. Montgomery E, Goldblum JR, Greenson JK, et al. Dysplasia as a predictive marker for invasive carcinoma in Barrett esophagus: A follow-up study based on 138 cases from a diagnostic variability study. Hum Pathol. 2001;32:379–388
  31. Schnell TG, Sontag SJ, Chejfec G, et al. Long-term nonsurgical management of Barrett's esophagus with high-grade dysplasia. Gastroenterology. 2001;120:1607–1619
  32. Weston AP, Sharma P, Topalovski M, et al. Long-term follow-up of Barrett's high-grade dysplasia. Am J Gastroenterol. 2000;95:1888–1893
  33. Overholt BF, Lightdale CJ, Wang KK, et al. Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett's esophagus: international, partially blinded, randomized phase III trial. Gastrointest Endosc. 2005;62:488–498
  34. Rubenstein JH, Sonnenberg A, Davis J, et al. Effect of a prior endoscopy on outcomes of esophageal adenocarcinoma among United States veterans. Gastrointest Endosc. 2008;68:849–855
  35. Inadomi JM, Sampliner R, Lagergren J, et al. Screening and surveillance for Barrett esophagus in high-risk groups: a cost-utility analysis. Ann Intern Med. 2003;138:176–186
  36. Hage M, Siersema PD, Vissers KJ, et al. Genomic analysis of Barrett's esophagus after ablative therapy: persistence of genetic alterations at tumor suppressor loci. Int J Cancer. 2006;118:155–160
  37. Rubenstein JH, Vakil N, Inadomi JM. The cost-effectiveness of biomarkers for predicting the development of oesophageal adenocarcinoma. Aliment Pharmacol Ther. 2005;22:135–146
  38. Vij R, Triadafilopoulos G, Owens DK, et al. Cost-effectiveness of photodynamic therapy for high-grade dysplasia in Barrett's esophagus. Gastrointest Endosc. 2004;60:739–756
  39. Shaheen NJ, Inadomi JM, Overholt BF, et al. What is the best management strategy for high grade dysplasia in Barrett's oesophagus? (A cost effectiveness analysis). Gut. 2004;53:1736–1744
  40. Hur C, Nishioka NS, Gazelle GS. Cost-effectiveness of photodynamic therapy for treatment of Barrett's esophagus with high grade dysplasia. Dig Dis Sci. 2003;48:1273–1283
  41. Comay D, Blackhouse G, Goeree R, et al. Photodynamic therapy for Barrett's esophagus with high-grade dysplasia: a cost-effectiveness analysis. Can J Gastroenterol. 2007;21:217–222

 This article has an accompanying continuing medical education activity on page 2387. Learning Objective: Upon completion of this CME exercise, successful learners will be able to analyze current evidence regarding the risk of cancer among patients with Barrett's esophagus, interpret studies of interventions to reduce cancer incidence, and assess current guidelines with respect to emerging data of management of patients with Barrett's esophagus.

 Conflicts of interest The authors disclose the following: R. Madanick has received an honorarium and N. Shaheen and J. Inadomi have received research support from Barrx Medical, maker of the radiofrequency ablation device. The remaining authors disclose no conflicts.

 Funding Supported by grants from the National Cancer Institute (R01 CA106773 - JMI) and National Institute of Diabetes and Digestive and Kidney Diseases (K24 DK080941 - JMI), National Institutes of Health. Supported by an unrestricted research grant from BARRX.

PII: S0016-5085(09)00348-5

doi: 10.1053/j.gastro.2009.02.062

Gastroenterology
Volume 136, Issue 7 , Pages 2101-2114.e6 , June 2009

Article Tools

* Image Usage & Resolution