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- W2000792633 abstract "Background: Experimental and epidemiologic studies suggest that ASA and COXIBs may help prevent the transformation of BE to esophageal adenocarcinoma (EAC) However, no pubhshed chemoprevention trials exist in patients with BE. Aim: To evaluate the potential cost-effectiveness of ASA or COXIB chemoprevention for BE patients. Methods: We created a Markov model for a cohort of 50 yr-old patients with BE. We compared discounted quality-adjusted lite-years (QALYs) and costs per patmnt (payor perspective) for six strategies: (1) No interveution; (2) ASA ($4/yr); (3) COXIB ($365/>~); (4) endoscopic surveillance (ES) (ACG guidelines); (5) ES+ASA; & (6) ES+COXIB. hr all strategies, patients took a daily proton pump inhibitor ($365/yr). Base case inputs included: EAC risk: 0.5%/pt-yr; EAC nsk-reduction with ASA or COXIB: 43%; esophagectmny mortality: 5%; major complications: O.002/pt-yr (ASA) & O.O01/pt-yr (COX1B); major ASA/COXIB complication mortality: 5%; endoscopy + biopsy' cost: $1000; nmjor endoscopy' complication: 0.3%; endoscopy mortality-: 0.005%, Base Case Results: ASA was dominant compared to no intervention or ES alone, i.e. it afforded more QALYs and cost less per patient (TABLE). Although COXIB yielded 0024 more QALY/pt than ASA, its incremental cost compared to ASA was $267,400/QALY gained. Adding ES tu ASA yielded 0.088 more QALY/pt than ASA alone, but at an incremental cost of $174,100/QALY gained. ES+ASA dominated ES alone. SenaitMty Analysis: ASA dominated no intervention if ASA reduced progression to EAC by -> 15% ASA dominated ES alone if ASA reduced progression to EAC by -> 36%. Across a range of EAC incidence, endoscopy costs, & ASA/procedure complications, none of the surveillance strategies cost < $50,000/QALY gained vs. As alone. Changing ES intervals or approach to dyspfasia didfft significantly aftect overall results. COXIB must cost < $ 8 0 ~ to cost < $50,000/ QALY gained vs. ASA. Conclusions: If proven efficacious, ASA chemoprevention against progression of BE to EAC may be the preferred strategy compared to no intervention or endoscopic surveillance alone, At current COXIB costs, potentially safer chemoprevention with COXIBs is unlikely to be cost-effective compared to ASA. These results support performing randomized trials of ASA chemoprevention in BE patients." @default.
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- W2000792633 date "2003-04-01" @default.
- W2000792633 modified "2023-09-25" @default.
- W2000792633 title "4-year follow-up of patients with barretts epithelium after ablation with argon plasma coagulation" @default.
- W2000792633 doi "https://doi.org/10.1016/s0016-5085(03)83212-2" @default.
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