17 research outputs found
Radiofrequency Ablation of Barrett's Esophagus Reduces Esophageal Adenocarcinoma Incidence and Mortality in a Comparative Modeling Analysis
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Optimizing Management of Patients With Barrett's Esophagus and Low-Grade or No Dysplasia Based on Comparative Modeling
Background & Aims: Endoscopic treatment is recommended for patients with Barrett's esophagus (BE) with high-grade dysplasia, yet clinical management recommendations are inconsistent for patients with BE without dysplasia (NDBE) or with low-grade dysplasia (LGD). We used a comparative modeling analysis to identify optimal management strategies for these patients. Methods: We used 3 independent population-based models to simulate cohorts of 60-year-old individuals with BE in the United States. We followed up each cohort until death without surveillance and treatment (natural disease progression), compared with 78 different strategies of management for patients with NDBE or LGD. We determined the optimal strategy using cost-effectiveness analyses, at a willingness-to-pay threshold of 5.7 million per 1000 men with BE. Surveillance and treatment of men with BE prevented 23% to 75% of cases of esophageal adenocarcinoma, but increased costs to 17.3 million per 1000 men with BE. The optimal strategy was surveillance every 3 years for men with NDBE and treatment of LGD after confirmation by repeat endoscopy (incremental cost-effectiveness ratio, 36,045/QALY). Conclusions: Based on analyses from 3 population-based models, the optimal management strategy for patient with BE and LGD is endoscopic eradication, but only after LGD is confirmed by a repeat endoscopy. The optimal strategy for patients with NDBE is endoscopic surveillance, using a 3-year interval for men and a 5-year interval for women
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Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening.
BackgroundThe ColonCancerCheck screening program for colorectal cancer (CRC) in Ontario, Canada, is considering switching from biennial guaiac fecal occult blood test (gFOBT) screening between age 50-74 years to the more sensitive, but also less specific fecal immunochemical test (FIT). The aim of this study is to estimate whether the additional benefits of FIT screening compared to gFOBT outweigh the additional costs and harms.MethodsWe used microsimulation modeling to estimate quality adjusted life years (QALYs) gained and costs of gFOBT and FIT, compared to no screening, in a cohort of screening participants. We compared strategies with various age ranges, screening intervals, and cut-off levels for FIT. Cost-efficient strategies were determined for various levels of available colonoscopy capacity.ResultsCompared to no screening, biennial gFOBT screening between age 50-74 years provided 20 QALYs at a cost of CAN333,300 per 1000 participants, compared to gFOBT. Without restrictions in colonoscopy capacity, FIT (with a low cut-off level of 50 ng Hb/ml) every year between age 45-80 years was the most cost-effective strategy providing 27 extra QALYs gained per 1000 participants, while saving CAN$448,300.InterpretationCompared to gFOBT screening, switching to FIT at a high cut-off level could increase the health benefits of a CRC screening program without considerably increasing colonoscopy demand
Test characteristics of the screening tests used in the model.
<p>Test characteristics of the screening tests used in the model.</p
Discounted total costs and discounted QALYs gained, per 1,000 participants, of the gFOBT and FIT screening strategies compared to no screening.
<p>QALY: quality adjusted life year; gFOBT: guaiac fecal occult blood test; FIT: fecal immunochemical test. Current screening strategy in Ontario: biennial gFOBT, between age 50–74. Strategies are varied by age at starting screening, age at stopping screening, screening interval, and FIT cut-off level. The cost-effective strategies are connected by the efficient frontier. Costs (expressed in 2013 Canadian dollars) and QALYs are discounted by 3% per year.</p
Overview of the current gFOBT screening strategy in Ontario, and efficient FIT screening strategies, compared to no screening<sup>*</sup>.
<p>Outcomes per 1,000 participants.</p
Cost estimates used in the model (2013 Canadian dollars).
<p>Cost estimates used in the model (2013 Canadian dollars).</p
Undiscounted intermediate model outcomes per 1,000 participants, compared to no screening.
<p>Undiscounted intermediate model outcomes per 1,000 participants, compared to no screening.</p