Critical appraisal:Inadomi JM, Somsouk M, Madanick RD, Thomas JP, Shaheen NJ 2009 4

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Critical Appraisal

Article being appraised

Inadomi JM, Somsouk M, Madanick RD, Thomas JP, Shaheen NJ. A cost-utility analysis of ablative therapy for Barrett's esophagus. Gastroenterology 2009 Jun;136(7):2101-2114.e1-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19272389.


Applicable clinical question
Result of appraisal

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Reason for decision

This is a hypothetical cost modelling study examining different intervention with ablation therapies that include PDT, RFA, MPEC and APC. The model uses different numbers about risk of progression and treatment efficacy taken from the literature. These are all applied to a hypothetical cohort of patients. It does not provide original data about to the value of RFA in ablation of Barrett's mucosa. The study does conclude that ablation could be the best option in patients with Barrett's oesophagus and HGD. There may also be a role in patients with LGD or no dysplasia depending on the durability of the ablation and whether long term surveillance can be discontinued. At present surveillance continues in all non-dysplastic patients who have received ablative therapy and therefore there is no cost benefit for ablation therapy.


Completed by

Dr Mark Schoeman MBBS, PhD, FRACP, AGAF


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Article
Inadomi JM, Somsouk M, Madanick RD, Thomas JP, Shaheen NJ. A cost-utility analysis of ablative therapy for Barrett's esophagus. Gastroenterology 2009 Jun;136(7):2101-2114.e1-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19272389.
Assigned to
User:Mark.schoeman
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


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