Department of Luminal Gastroenterology, Southampton General Hospital, UK.
Aliment Pharmacol Ther. 2010 Dec;32(11-12):1332-42. doi: 10.1111/j.1365-2036.2010.04450.x. Epub 2010 Sep 13.
In the UK, oesophagectomy is the current recommendation for patients with persistent high-grade dysplasia in Barrett's oesophagus. Radiofrequency ablation is an alternative new technology with promising early trial results.
To undertake a cost-utility analysis comparing these two strategies.
We constructed a Markov model to simulate the natural history of a cohort of patients with high-grade dysplasia in Barrett's oesophagus undergoing one of two treatment options: (i) oesophagectomy or (ii) radiofrequency ablation followed by endoscopic surveillance with oesophagectomy for high-grade dysplasia recurrence or persistence.
In the base case analysis, radiofrequency ablation dominated as it generated 0.4 extra quality of life years at a cost saving of £1902. For oesophagectomy to be the most cost-effective option, it required a radiofrequency ablation treatment failure rate (high-grade dysplasia persistence or progression to cancer) of >44%, or an annual risk of high-grade dysplasia recurrence or progression to cancer in the ablated oesophagus of >15% per annum. There was an 85% probability that radiofrequency ablation remained cost-effective at the NICE willingness to pay threshold range of £20 000-30 000.
Radiofrequency ablation is likely to be a cost-effective option for high-grade dysplasia in Barrett's oesophagus in the UK.
在英国，对于 Barrett 食管中持续性高级别异型增生的患者，推荐进行食管切除术。射频消融术是一种替代的新技术，具有有前途的早期试验结果。
对这两种策略进行成本效益分析。
我们构建了一个马尔可夫模型，以模拟一组接受以下两种治疗方案之一的高级别异型增生 Barrett 食管患者的自然史：（i）食管切除术或（ii）射频消融术，随后对高级别异型增生复发或持续存在进行内镜监测和食管切除术。
在基本情况分析中，射频消融术具有优势，因为它在节省 £1902 的成本的同时增加了 0.4 个额外的生活质量年。为了使食管切除术成为最具成本效益的选择，它需要射频消融术治疗失败率（高级别异型增生持续存在或进展为癌症）>44%，或者消融食管中每年高级别异型增生复发或进展为癌症的风险>15%。在 NICE 愿意支付的 £20000-30000 范围内，射频消融术很可能仍然具有成本效益，概率为 85%。
射频消融术可能是英国 Barrett 食管中高级别异型增生的一种具有成本效益的选择。
