A Cost-Effectiveness Analysis Of An Adenocarcinoma Risk Prediction Multi-Biomarker Assay For Patients With Barrett's...

Area of Science:

• Gastroenterology
• Oncology
• Health Economics

Background:

• Barrett's Esophagus (BE) carries a risk of progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC).
• Current standard of care (SOC) involves surveillance and treatment guidelines with varying effectiveness.
• Stratifying BE patients by risk is crucial for optimizing clinical decisions.

Purpose of the Study:

• To evaluate the cost-effectiveness of a quantitative multi-biomarker assay (the Assay) for risk stratification in BE patients.
• To compare the Assay-directed care strategy against the current SOC for BE surveillance and treatment.
• To assess the impact of the Assay on clinical decisions and patient outcomes.

Main Methods:

• Markov decision modeling and simulation were employed to compare costs and quality-adjusted life-years (QALYs).
• The analysis adopted the perspective of a US health insurer within an integrated health system.
• Model parameters were derived from literature, clinical validation studies, and payer reimbursement data.

Main Results:

• Assay-directed care demonstrated an incremental cost-effectiveness ratio (ICER) of $52,483/QALY over a 5-year period.
• This strategy increased endoscopic treatments by 58.4%, significantly reducing progression to HGD (51.7%), EAC (47.1%), and EAC-related deaths (37.6%).
• Sensitivity analysis showed a 57.3% probability of the Assay being cost-effective at a $100,000/QALY threshold.

Conclusions:

• The multi-biomarker Assay is projected to be cost-effective within 5 years for managing BE.
• It enhances surveillance and treatment effectiveness, leading to improved patient outcomes.
• The Assay contributes to a reduction in the progression of BE to HGD and EAC, and fewer associated deaths.