Barrett’s Esophagus Treatment Dilemma: Pills Versus Operation: Statistical Analysis and Cost/effectiveness

INTRODUCTION:Controversy over the management of barrett’s esophagus has been difficult to resolve due to the low incidence of progression to adenocarcinoma. A prospective study comparing thousands of patients with barretts esophagus randomized either into PPI or antireflux surgery group is costly and no likely to be perfomed. This study examined possible clinical outcomes of the two strategies and cost/effectiveness associated with treatment of Barrett’s esophagus.

METHODS: A decision analysis tree (Markov Monte Carlo model) was used to track hypothetical cohort of patients with Barrett’s esophagus. The input variables were estimated by a pooled analysis of 74 published studies on a total of 23,368 patients. Possible clinical outcomes of the two treatment strategies, laparoscopic Antireflux procedure (LARP) vs. proton pump inhibitors (PPI), were analyzed. Cost/effectiveness ratio was calculated based on average cost and expected effectiveness of the two treatment strategies.

RESULTS: Expected utility score for laparoscopic antireflux surgery was calculated to be .93 compared to that for PPI of .89. The model was sensitive to alterations in the probabilities of Regression, Progression and Death rates demonstrating preference to antireflux surgery over PPI alone. Cost/utility ratio for antireflux surgery was 38.9, and for PPI – 28.7, indicating favorable cost/effectiveness for PPI treatment.

CONCLUSIONS: Our model, based on a comprehensive literature review, predicted that laparoscopic antireflux surgery was more effective strategy to achieve regression of Barrett’s esophagus. At the same time, PPI alone was less costly treatment strategy for patients with Barrett’s esophagus.

Session: Podium Presentation

Program Number: S102

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