Menon Shyam, Norman Richard, Mannath Jayan, Iyer Prasad G, Ragunath Krish
The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Curtin University, Perth, Australia.
Endosc Int Open. 2022 Aug 15;10(8):E1053-E1064. doi: 10.1055/a-1858-0945. eCollection 2022 Aug.
Radiofrequency ablation (RFA) for dysplastic Barrett's esophagus (BE) has resulted in a paradigm shift in the management of BE. Despite widespread adoption of RFA, the optimal surveillance interval of the ablated zone is unclear. A patient-level discrete time cycle Markov model was developed to model clinical surveillance strategies post-RFA for BE. Three surveillance strategies were examined: the American College of Gastroenterology (ACG) strategy based on ACG guidelines for post-RFA surveillance, the Cotton strategy based on data from the USA and UK RFA registries, and the UK strategy in line with surveillance strategies in UK centers. Monte-Carlo deterministic and probabilistic analyses were performed over 10,000 iterations (i. e., representing 10,000 patient journeys) and sensitivity analyses were carried out on the variables used in the model. On base-case analysis, the ACG strategy was the most cost-effective strategy, at a mean cost of £ 11,733 ($ 16,396) (standard deviation (SD) 1520.15) and a mean effectiveness of 12.86 (SD 0.07) QALYs. Probabilistic sensitivity analysis demonstrated that the ACG model was the most cost-effective strategy with a net monetary benefit (NMB) of £ 5,136 ($ 7177) (SD 241) compared to the UK strategy and a NMB of £ 7017 ($ 9,806) (SD 379) compared to the Cotton strategy. At a willingness to pay (WTP) threshold of £ 20,000 ($ 27,949), the ACG model was superior to the other strategies as the most cost-effective strategy. A post-RFA surveillance strategy based on the ACG guidelines seems to be the most cost-effective surveillance option.
射频消融术（RFA）用于治疗发育异常的巴雷特食管（BE），这已导致BE管理模式的转变。尽管RFA已被广泛应用，但消融区的最佳监测间隔仍不明确。我们开发了一个患者层面的离散时间周期马尔可夫模型，以模拟RFA术后BE的临床监测策略。研究了三种监测策略：基于美国胃肠病学会（ACG）RFA术后监测指南的ACG策略、基于美国和英国RFA登记数据的科顿策略以及与英国各中心监测策略一致的英国策略。进行了10000次迭代的蒙特卡洛确定性和概率分析（即代表10000名患者的病程），并对模型中使用的变量进行了敏感性分析。在基础病例分析中，ACG策略是最具成本效益的策略，平均成本为11733英镑（16396美元）（标准差（SD）1520.15），平均有效性为12.86（SD 0.07）质量调整生命年（QALYs）。概率敏感性分析表明，与英国策略相比，ACG模型是最具成本效益的策略，净货币效益（NMB）为5136英镑（7177美元）（SD 241）；与科顿策略相比，NMB为7017英镑（9806美元）（SD 379）。在支付意愿（WTP）阈值为20000英镑（27949美元）时，ACG模型作为最具成本效益的策略优于其他策略。基于ACG指南的RFA术后监测策略似乎是最具成本效益的监测选择。
