Endoscopy 2024; 56(10): 727-736
DOI: 10.1055/a-2317-8184
Original article

Stratification of Barrett’s esophagus surveillance based on p53 immunohistochemistry: a cost-effectiveness analysis by an international collaborative group

1   Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8692)
,
Richard Norman
2   Health Economist, School of Population Health, Curtin University, Perth, Australia (Ringgold ID: RIN1649)
,
Prasad G. Iyer
3   Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States (Ringgold ID: RIN6915)
,
Krish Ragunath
4   Curtin Medical School, Curtin University, Perth, Australia (Ringgold ID: RIN1649)
5   Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia (Ringgold ID: RIN6508)
› Author Affiliations


Abstract

Background Surveillance of nondysplastic Barrett’s esophagus (NDBE) is recommended to identify progression to dysplasia; however, the most cost-effective strategy remains unclear. Mutation of TP53 or aberrant expression of p53 have been associated with the development of dysplasia in BE. We sought to determine if surveillance intervals for BE could be stratified based on p53 expression.

Methods A Markov model was developed for NDBE. Patients with NDBE underwent p53 immunohistochemistry (IHC) and those with abnormal p53 expression underwent surveillance endoscopy at 1 year, while patients with normal p53 expression underwent surveillance in 3 years. Patients with dysplasia underwent endoscopic therapy and surveillance.

Results On base-case analysis, the strategy of stratifying surveillance based on abnormal p53 IHC was cost-effective relative to conventional surveillance and a natural history model, with an incremental cost-effectiveness ratio (ICER) of $8258 for p53 IHC-based surveillance. Both the conventional and p53-stratified surveillance strategies dominated the natural history model. On probabilistic sensitivity analysis, the p53 IHC strategy ($28 652; 16.78 quality-adjusted life years [QALYs]) was more cost-effective than conventional surveillance ($25 679; 16.17 QALYs) with a net monetary benefit of $306 873 compared with conventional surveillance ($297 642), with an ICER <$50 000 in 96% of iterations. The p53-stratification strategy was associated with a 14% reduction in the overall endoscopy burden and a 59% increase in dysplasia detection.

Conclusion A surveillance strategy for BE based on abnormal p53 IHC is cost-effective relative to a conventional surveillance strategy and is likely to be associated with higher rates of dysplasia diagnosis.

Supplementary Material



Publication History

Received: 14 January 2024

Accepted after revision: 02 May 2024

Accepted Manuscript online:
02 May 2024

Article published online:
28 June 2024

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