Stratification of Barrett's esophagus surveillance based on p53 immunohistochemistry: a cost-effectiveness analysis...

Area of Science:

• Gastroenterology
• Oncology
• Medical Economics

Background:

• Nondysplastic Barrett's esophagus (NDBE) surveillance is crucial for detecting progression to dysplasia.
• Current cost-effective surveillance strategies for NDBE remain unclear.
• TP53 mutation or aberrant p53 expression are linked to Barrett's esophagus (BE) dysplasia development.

Purpose of the Study:

• To evaluate the cost-effectiveness of stratifying BE surveillance intervals based on p53 expression.
• To determine if p53 immunohistochemistry (IHC) can optimize NDBE surveillance.

Main Methods:

• A Markov model was utilized for NDBE surveillance.
• Patients with NDBE underwent p53 IHC.
• Surveillance endoscopy was scheduled at 1 year for abnormal p53 expression and 3 years for normal p53 expression.

Main Results:

• P53 IHC-based surveillance was cost-effective, with an ICER of $8258 compared to conventional surveillance.
• Probabilistic sensitivity analysis showed p53 IHC strategy was more cost-effective (16.78 QALYs vs. 16.17 QALYs).
• This strategy reduced endoscopy burden by 14% and increased dysplasia detection by 59%.

Conclusions:

• A BE surveillance strategy incorporating abnormal p53 IHC is cost-effective.
• This approach is associated with higher rates of dysplasia diagnosis.
• Stratifying surveillance by p53 expression optimizes NDBE management.