Volume 144, Issue 1, Pages e6 (January 2013)

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Presentation transcript:

Volume 144, Issue 1, Pages 62-73.e6 (January 2013) Health Benefits and Cost Effectiveness of Endoscopic and Nonendoscopic Cytosponge Screening for Barrett's Esophagus Tatiana Benaglia, Linda D. Sharples, Rebecca C. Fitzgerald, Georgios Lyratzopoulos Gastroenterology Volume 144, Issue 1, Pages 62-73.e6 (January 2013) DOI: 10.1053/j.gastro.2012.09.060 Copyright © 2013 AGA Institute Terms and Conditions

Figure 1 Model structure. Decision tree followed by a semi-Markov model. Transition rates between stages (progression or regression) are determined by natural history of the Barrett's esophagus. Patients with nondysplastic Barrett's and low-grade dysplasia will undergo surveillance. In the base case, patients with treatable symptomatic cancer are managed by esophagectomy and patients with surveillance-detected high-grade dysplasia or intramucosal cancer are managed by esophagectomy or endotherapy. Gastroenterology 2013 144, 62-73.e6DOI: (10.1053/j.gastro.2012.09.060) Copyright © 2013 AGA Institute Terms and Conditions

Figure 2 Cost-effectiveness plane comparing each screening method against no screening/no intervention for different management strategies: (A) endotherapy, (B) esophagectomy. The black dashed line represents the threshold of $45K per QALY. Gastroenterology 2013 144, 62-73.e6DOI: (10.1053/j.gastro.2012.09.060) Copyright © 2013 AGA Institute Terms and Conditions

Figure 3 (A) Cost-effectiveness acceptability curve. (B) Cost-effectiveness acceptability frontier. For a given threshold of incremental cost-effectiveness ratio (willingness-to-pay), the cost-effectiveness acceptability curve (top) gives the probability that each strategy is cost effective, and the cost-effectiveness acceptability frontier (bottom) indicates the probability that the optimal strategy is cost effective. Gastroenterology 2013 144, 62-73.e6DOI: (10.1053/j.gastro.2012.09.060) Copyright © 2013 AGA Institute Terms and Conditions

Figure 4 (A-D) Deterministic sensitivity analysis tornado diagrams for each of the 4 screening strategies modeled. Within each of the 4 panels, horizontal bands represent variation in ICERs for 1-way deterministic sensitivity analysis scenarios. The vertical line on each diagram represents the ICER for the main model (see also Supplementary Table 3). Gastroenterology 2013 144, 62-73.e6DOI: (10.1053/j.gastro.2012.09.060) Copyright © 2013 AGA Institute Terms and Conditions

Supplementary Figure 1 (A–E) Survival curves for the entire cohort compared to the survival from UK Life Tables. Gastroenterology 2013 144, 62-73.e6DOI: (10.1053/j.gastro.2012.09.060) Copyright © 2013 AGA Institute Terms and Conditions