PMID- 18523886
OWN - NLM
STAT- MEDLINE
DCOM- 20090203
LR  - 20211020
IS  - 0163-2116 (Print)
IS  - 0163-2116 (Linking)
VI  - 53
IP  - 12
DP  - 2008 Dec
TI  - Cost-effectiveness of palliation of unresectable esophageal cancer.
PG  - 3103-11
LID - 10.1007/s10620-008-0302-2 [doi]
AB  - INTRODUCTION: Different modalities of palliation for obstructive symptoms in 
      patients with unresectable esophageal cancer (EC) exist. However, these 
      therapeutic alternatives have significant differences in costs and effectiveness. 
      METHODS: A Markov model was designed to compare the cost-effectiveness (CE) of 
      self-expandable stent (SES), brachytherapy and laser in the palliation of 
      unresectable EC. Patients were assigned to one of the strategies, and the 
      improvement in swallowing function was compared given the treatment efficacy, 
      probability of survival, and risks of complications associated to each strategy. 
      Probabilities and parameters for distribution were based on a 9-month time frame. 
      RESULTS: Under the base-case scenario, laser has the lowest CE ratio, followed by 
      brachytherapy at an incremental cost-effectiveness ratio (ICER) of $4,400.00, and 
      SES is a dominated strategy. In the probabilistic analysis, laser is the strategy 
      with the highest probability of cost-effectiveness for willingness to pay (WTP) 
      values lower than $3,201 and brachytherapy for all WTP yielding a positive net 
      health benefit (NHB) (threshold $4,440). The highest probability of 
      cost-effectiveness for brachytherapy is 96%, and consequently, selection of 
      suboptimal strategies can lead to opportunity losses for the US health system, 
      ranging from US$ 4.32 to US$ 38.09 million dollars over the next 5-20 years. 
      CONCLUSION: Conditional to the WTP and current US Medicare costs, palliation of 
      unresectable esophageal cancers with brachytherapy provides the largest amount of 
      NHB and is the strategy with the highest probability of CE. However, some level 
      of uncertainly remains, and wrong decisions will be made until further knowledge 
      is acquired.
FAU - da Silveira, Eduardo B
AU  - da Silveira EB
AD  - Division of Gastroenterology, Portland VA Medical Center, Oregon Health and 
      Science University, 3710 SW US Veterans Hospital Road, P3GI, Portland, OR, 97239, 
      USA. eduardo.dasilveira@va.gov
FAU - Artifon, Everson L
AU  - Artifon EL
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20080604
PL  - United States
TA  - Dig Dis Sci
JT  - Digestive diseases and sciences
JID - 7902782
SB  - IM
MH  - Brachytherapy/economics
MH  - Cost-Benefit Analysis
MH  - *Decision Support Techniques
MH  - Deglutition Disorders/economics/etiology/therapy
MH  - Esophageal Neoplasms/complications/*economics/*therapy
MH  - Humans
MH  - Laser Therapy/economics
MH  - *Models, Statistical
MH  - Palliative Care/*economics/methods
MH  - Stents/economics
MH  - United States
EDAT- 2008/06/05 09:00
MHDA- 2009/02/04 09:00
CRDT- 2008/06/05 09:00
PHST- 2008/02/01 00:00 [received]
PHST- 2008/04/10 00:00 [accepted]
PHST- 2008/06/05 09:00 [pubmed]
PHST- 2009/02/04 09:00 [medline]
PHST- 2008/06/05 09:00 [entrez]
AID - 10.1007/s10620-008-0302-2 [doi]
PST - ppublish
SO  - Dig Dis Sci. 2008 Dec;53(12):3103-11. doi: 10.1007/s10620-008-0302-2. Epub 2008 
      Jun 4.