Economic evaluation of Cytosponge®-trefoil factor 3 for Barrett esophagus: A cost-utility analysis of randomised controlled trial data.

BACKGROUND

Esophageal adenocarcinoma has a very poor prognosis unless detected early. The Cytosponge-trefoil factor 3 (TFF3) is a non-endoscopic test for Barrett esophagus, a precursor of esophageal adenocarcinoma. Randomised controlled trial data from the BEST3 trial has shown that an offer of Cytosponge-TFF3 in the primary care setting in England to individuals on medication for acid reflux increases detection of Barrett esophagus 10-fold over a year compared with standard care. This is an economic evaluation of Cytosponge-TFF3 screening versus usual care using data from the BEST3 trial which took place between 20th March 2017 and 21st March 2019.

METHODS

A Markov model with a one-year cycle-length and a lifetime time horizon was created, adapting previous modeling work on Cytosponge screening. The impact of one round of Cytosponge screening was modelled in patients with a median age of 69 years (based on BEST3 trial population). Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were conducted on model parameters.

FINDINGS

Per person, one round of Cytosponge-TFF3 screening, including confirmatory endoscopy and treatment, in the intervention arm costed £82 more than usual care and generated an additional 0.015 quality-adjusted life-years (QALYs) at an ICER of £5,500 per QALY gained. Probabilistic sensitivity analysis gave an ICER of £5,405 (95% CI -£6,791 to £17,600). The average QALY gain per person is small because the majority of patients in the model will not develop BE and therefore will have no resulting change in their utility, however the small proportion of patients who are identified with BE dysplasia or cancer derive large benefit. At a willingness-to-pay threshold of £20,000 per QALY, the probability that Cytosponge-TFF3 was cost-effective was over 90%.

INTERPRETATION

Using data from a pragmatic randomised trial, one-off Cytosponge-TFF3 screen is cost-effective relative to usual care for patients with gastro-esophageal reflux disease, despite relatively low uptake and an older population in this trial setting than previously modelled. Improving Cytosponge-TFF3 uptake and targeting younger patients is likely to further improve cost-effectiveness.

Informations de copyright

© 2021 The Authors.

Déclaration de conflit d'intérêts

BM reports employment contract by Cyted, outside the submitted work. PS reports grants from Cancer Research UK and Innovate UK, during the conduct of the study; consulting fees from GRAIL Inc, grants from NIHR, Yorkshire Cancer Research and Public Health England, and being in an advisory committee for NHS England on use of Cytosponge (unpaid) and in one on NCRI screening, prevention and Early Detection (unpaid) outside the submitted work. RM reports payment made to Cancer Research UK. RCF reports grants from Cancer Research UK, during the conduction of the study, and has a patent Cytosponge TM co-inventor licensed to Medtronic by the Medical Research Council, reports fees from presentation by Medtronic, is an Editor at the American Association Journal of Gastroeneteroly and co-founder and share-holder of Cyted Ltd an early detection company, outside the submitted work. SM & NS reports grants from Cancer Research UK and from Innovate UK, during the conduct of the study.