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Article Title

A Cost-Effectiveness Analysis of an Adenocarcinoma Risk Prediction Biomarker Test for Patients With Barrett’s Esophagus

Publication Date

8-10-2017

Keywords

cancer, clinical decision-making, health care costs/resource use, economic studies

Abstract

Background: Current surveillance guidelines for identifying patients with Barrett’s esophagus (BE) at high risk of progressing to esophageal adenocarcinoma (EAC) are considered inefficient because less than 1% of all BE patients are likely to develop EAC. A new tissue systems pathology risk prediction test (RPT) stratifies BE patients by their risk of progression to high-grade dysplasia or EAC by assigning them to low-, intermediate- or high-risk categories based on an individualized risk score. These categories can be used to guide endoscopic surveillance and treatment decisions. This study evaluates the cost-effectiveness of this new RPT versus the current standard of care for surveillance and treatment of BE.

Methods: Decision analysis with Markov modeling and simulation were used to compare cost and quality-adjusted life-years (QALYs) from the perspective of a U.S. health insurer with care delivered by an integrated health system. Model assumptions and disease progression probabilities were derived from the literature. Performance metrics for the RPT were from an independent clinical validation study. Cost of the RPT was based on reimbursement rates from multiple payers. Other costs were derived from Geisinger Health System payment data.

Results: Base-case results of a 5-year model indicated an incremental cost-effectiveness ratio (ICER) of the RPT compared to the standard of care of $50,181/QALY in 2012 U.S. dollars. RPT versus standard of care total surveillance endoscopies over the 5-year period were 17.6% lower, and endoscopic treatments (radiofrequency ablation and/or endoscopic mucosal resection) were 64.7% higher. The RPT also reduced the number of cases of high-grade dysplasia, EAC and EAC-related deaths by 55.1%, 49.6% and 37.1%, respectively. Sensitivity analysis indicated that the probability of the RPT being cost-effective compared to the standard of care was 56.4% at the $100,000/QALY acceptability threshold. The following changes in the model variables can make the RPT more cost-effective: higher BE-to-EAC progression rate, lower RPT cost, higher endoscopy cost, lower EAC utility, and higher physician RPT adherence/use.

Conclusion: The new RPT is cost-effective after 5 years and improves patient outcomes due to improving the effectiveness of surveillance and treatment protocols, resulting in fewer patients transitioning to high-grade dysplasia, EAC and death.

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