The cost-effectiveness of radiofrequency ablation for treating patients with gastric antral vascular ectasia refractory to first line endoscopic therapy

Abstract

Objective

This economic evaluation aims to provide a preliminary assessment of the cost-effectiveness of radiofrequency ablation (RFA) compared with argon plasma coagulation (APC) when used to treat APC-refractory gastric antral vascular ectasia (GAVE) in symptomatic patients.

Methods

A Markov model was constructed to undertake a cost-utility analysis for adults with persistent symptoms secondary to GAVE refractory to first line endoscopic therapy. The economic evaluation was conducted from a UK NHS and personal social services (PSS) perspective, with a 20-year time horizon, comparing RFA with APC. Patients transfer between health states defined by haemoglobin level. The clinical effectiveness data were sourced from expert opinion, resource use and costs were reflective of the UK NHS and benefits were quantified using Quality Adjusted Life Years (QALYs) with utility weights taken from the literature. The primary output was the Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per QALY gained.

Results

Over a lifetime time horizon, the base case ICER was £4840 per QALY gained with an 82.2% chance that RFA was cost-effective at a threshold of £20,000 per QALY gained. The model estimated that implementing RFA would result in reductions in the need for intravenous iron, endoscopic intervention and requirement for blood transfusions by 27.1%, 32.3% and 36.5% respectively. Compared to APC, RFA was associated with an estimated 36.7% fewer procedures.

Conclusions

RFA treatment is likely to be cost-effective for patients with ongoing symptoms following failure of first line therapy with APC and could lead to substantive reductions in health care resource.

Keywords:

• Radiofrequency ablation
• gastric antral vascular ectasia
• argon plasma coagulation
• cost-effective

Transparency

Declaration of funding

Funding for this study was provided by Medtronic, who commissioned SM, JM, and HD to provide consultancy, develop the early economic model, and prepare the manuscript. Medtronic also employs CL.

Declaration of financial/other relationships

SM, JM and HD are employees of York Health Economics Consortium, who were commissioned by Medtronic to provide consultancy and develop the early economic model and to prepare the manuscript. LL reports grants from Medtronic and Pentax Medical, outside the submitted work. CL is a full time employee of Medtronic. There is no further support from any organisation for the submitted work and no further financial relationships with any organisations that might have an interest in the submitted work in the previous three years. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

JM, HD, MS and SM have been involved in model design and construction. All authors have been involved in drafting and editing or reviewing the manuscript. DG, LL, CMurray, CMagee, HS and RH have been involved in providing clinical advice for inputs in the model.

Acknowledgements

No assistance in the preparation of this article is to be declared.

Notes

i Barrx is a trademark of Medtronic, Sunnyvale, CA, USA.