Centre for Applied Health Economics, Griffith Health Institute, Griffith University, Logan Campus, University Drive, Meadowbrook, Queensland 4131, Australia.
J Gastrointest Surg. 2012 Aug;16(8):1451-61. doi: 10.1007/s11605-012-1911-9. Epub 2012 May 30.
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.
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.
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).
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.
本研究旨在综合食管腺癌和高级别异型增生（HGD）当前治疗途径的成本和健康结果，并对替代管理方案的净临床和经济效益进行建模比较。
构建并验证了一个基于肿瘤分期的食管腺癌治疗实际情况的决策分析模型。该模型综合了从流行病学数据集、已发表文献和专家意见中提取的治疗概率、生存、生活质量和资源利用情况。对当前实践与五种修改后的治疗方案的假设场景进行了比较分析。
在 5 年内，各 T 分期的结果范围从 HGD 的 4.06 个质量调整生命年和 3179 美元的成本到 T4 期的 1.62 个质量调整生命年和 50226 美元的成本。T1 期更多地采用内镜黏膜切除术和降低食管切除术死亡率至 0-3%的措施会带来适度的收益，而 T3 期就诊患者比例降低 20%则会带来 4971 美元的增量净效益（95%置信区间，1560-8368 美元）。
这些发现支持采取措施促进早期诊断，例如开发风险评估流程或巴雷特食管的内镜监测。与早期检测策略的预测收益相比，其他策略的增量净货币收益相对较小。
