Faculty Opinions recommendation of Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett's esophagus: international, partially blinded, randomized phase III trial.

2006 ◽  
Author(s):  
Laurence Lovat
Keyword(s):  
Photodynamic Therapy ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
High Grade Dysplasia ◽  
Phase Iii ◽  
High Grade ◽  
Phase Iii Trial ◽  
Porfimer Sodium

scholarly journals Photodynamic Therapy for Barrett’s Esophagus with High-Grade Dysplasia: A Cost-Effectiveness Analysis

2007 ◽  
Vol 21 (4) ◽  
pp. 217-222 ◽  
Author(s):  
Dan Comay ◽  
Gord Blackhouse ◽  
Ron Goeree ◽  
David Armstrong ◽  
John K Marshall
Keyword(s):  
Photodynamic Therapy ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Barrett’S Esophagus ◽  
Probabilistic Analysis ◽  
Barrett's Esophagus ◽  
Cost Effective ◽  
High Grade Dysplasia ◽  
High Grade ◽  
Male Patients

OBJECTIVES: To assess the cost-effectiveness of photodynamic therapy (PDT) and esophagectomy (ESO) relative to surveillance (SURV) for patients with Barrett’s esophagus (BE) and high-grade dysplasia (HGD).METHODS: A Markov decision tree was constructed to estimate costs and health outcomes of PDT, ESO and SURV in a hypothetical cohort of male patients, 50 years of age, with BE and HGD. Outcomes included unadjusted life-years (LYs) and quality-adjusted LYs (QALYs). Direct medical costs (2003 CDN$) were measured from the perspective of a provincial ministry of health. The time horizon for the model was five years (cycle length three months), and costs and outcomes were discounted at 3%. Model parameters were assigned unique distributions, and a probabilistic analysis with 10,000 Monte Carlo simulations was performed.RESULTS: SURV was the least costly strategy, followed by PDT and ESO, but SURV was also the least effective. In terms of LYs, the incremental cost-effectiveness ratios were $814/LY for PDT versus SURV and $3,397/LY for ESO versus PDT. PDT dominated ESO for QALYs in the base-case. The incremental cost-effectiveness ratio of PDT versus SURV was $879/QALY. In probabilistic analysis, PDT was most likely to be cost-effective at willingness-to-pay (WTP) values between $100/LY and $3,500/LY, and ESO was most likely to be cost-effective for WTP values over $3500/LY. For quality-adjusted survival, PDT was most likely to be cost-effective for all WTP thresholds above $1,000/QALY. The likelihood that PDT was the most cost-effective strategy reached 0.99 at a WTP ceiling of $25,000/QALY.CONCLUSIONS: In male patients with BE and HGD, PDT and ESO are cost-effective alternatives to SURV.

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