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  • Modeling the Cost-effectiveness of Strategies for Treating Esophageal Adenocarcinoma and High-grade Dysplasia

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    Author(s)
    Gordon, Louisa
    Hirst, Nick
    C. Mayne, George
    I. Watson, David
    Bright, Timothy
    Cai, Wang
    P. Barbour, Andrew
    M. Smithers, Bernard
    C. Whiteman, David
    Eckermann, Simon
    Griffith University Author(s)
    Gordon, Louisa
    Hirst, Nick
    Year published
    2012
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    Abstract
    Objective 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. Methods 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 ...
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    Objective 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. Methods 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. Results 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). Conclusion 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.
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    Journal Title
    Journal of Gastrointestinal Surgery
    Volume
    16
    Issue
    8
    DOI
    https://doi.org/10.1007/s11605-012-1911-9
    Copyright Statement
    © 2012 Springer US. This is an electronic version of an article published in Journal of Gastrointestinal Surgery, August 2012, Volume 16, Issue 8, pp 1451-1461. The Journal of Gastrointestinal Surgery is available online at: http://link.springer.com/ with the open URL of your article.
    Subject
    Clinical sciences
    Publication URI
    http://hdl.handle.net/10072/47531
    Collection
    • Journal articles

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