Esteban José Miguel, González-Carro Pedro, Gornals Joan B, Collados Carlos, Álvarez María, Pérez-Mitru Alejandro, Serip Suzan
Endoscopy Unit, Digestive Department, Hospital Clínico San Carlos, Spain.
Digestive Unit, Complejo Hospitalario La Mancha Centro, Spain.
Rev Esp Enferm Dig. 2018 Mar;110(3):145-154. doi: 10.17235/reed.2017.5087/2017.
To assess the cost-effectiveness of introducing endoscopic treatment based on radiofrequency ablation plus endoscopic mucosal resection in selected patients into the standard of care of Barrett's esophagus patients with high-grade dysplasia or low-grade dysplasia in Spain.
The disease evolution was modeled via a semi-Markov model. The treatment strategies compared included endoscopic treatment based on radiofrequency ablation plus endoscopic mucosal resection and the Standard of Care (esophagectomy or palliative chemoradiotherapy according to disease status for high-grade dysplasia and endoscopic surveillance for low-grade dysplasia). Efficacy rates, transition probabilities and utility values were obtained from the literature. Clinical management patterns and resource use were modeled according to Spanish clinical expert opinion. Costs were expressed in euros (€) from 2016 reflecting the Spanish National Health System perspective. Sensitivity analyses were performed to assess the robustness of the model.
With respect to the Spanish Standard of Care, endoscopic treatment based on radiofrequency ablation plus endoscopic mucosal resection was a dominant strategy for high-grade dysplasia patients. When a willingness-to-pay threshold of €30,000 per quality-adjusted life-years gained was considered, this was cost-effective for low-grade dysplasia patients (€12,865 per quality-adjusted life-years gained). The sensitivity analyses supported the base case analysis results and pointed towards the main drivers of uncertainty in the model.
From a health care decision-maker, endoscopic treatment based on radiofrequency ablation plus endoscopic mucosal resection is the intervention of choice for dysplasic Barrett's esophagus patients in Spain.
评估在西班牙，将针对特定患者的基于射频消融加内镜黏膜切除术的内镜治疗引入巴雷特食管高级别异型增生或低级别异型增生患者的标准治疗方案中的成本效益。
通过半马尔可夫模型对疾病进展进行建模。比较的治疗策略包括基于射频消融加内镜黏膜切除术的内镜治疗以及标准治疗方案（根据高级别异型增生的疾病状态进行食管切除术或姑息性放化疗，对低级别异型增生进行内镜监测）。疗效率、转移概率和效用值均从文献中获取。根据西班牙临床专家意见对临床管理模式和资源使用进行建模。成本以2016年的欧元表示，反映西班牙国家卫生系统的视角。进行敏感性分析以评估模型的稳健性。
相对于西班牙的标准治疗方案，基于射频消融加内镜黏膜切除术的内镜治疗对于高级别异型增生患者是一种优势策略。当考虑每获得一个质量调整生命年的支付意愿阈值为30,000欧元时，对于低级别异型增生患者而言，这具有成本效益（每获得一个质量调整生命年为12,865欧元）。敏感性分析支持了基础病例分析结果，并指出了模型中不确定性的主要驱动因素。
从医疗保健决策者的角度来看，基于射频消融加内镜黏膜切除术的内镜治疗是西班牙异型增生性巴雷特食管患者的首选干预措施。
