Clinical Decisionmaking

Photodynamic therapy is a cost-effective treatment option for patients with high-grade dysplasia in Barrett's esophagus

The incidence of esophageal cancer is growing faster than any other type of cancer in the United States and has risen 300 percent in the last few decades. Photodynamic therapy (a type of laser therapy combined with medication is used to destroy abnormal esophageal lining) is a cost-effective option to esophagectomy (surgical removal or all or part of the esophagus) for patients with Barrett's esophagus and precancerous cells, according to a study supported in part by the Agency for Healthcare Research and Quality (T32 HS00028).

Individuals who suffer from chronic regurgitation (reflux) of the stomach contents up into the esophagus are at increased risk for developing Barrett's esophagus. In this condition, the stomach's digestive acids and other chemicals damage the normal lining of the esophagus, which is replaced by intestinal tissue. The development of high-grade dysplasia (HGD) in Barrett's esophagus is associated with a significantly increased risk of esophageal cancer. In fact, up to 60 percent of patients progress to esophageal cancer within 5 years of HGD diagnosis.

Researchers led by Rohini Vij, M.D., M.S., of Stanford University Medical Center, estimated the lifetime costs and benefits of four strategies to manage HGD in Barrett's esophagus: esophagectomy, endoscopic surveillance, photodynamic therapy followed by esophagectomy for residual HGD, and photodynamic therapy followed by endoscopic surveillance for residual HGD. Esophagectomy cost $24,045, with a life expectancy of 11.82 quality-adjusted life years (QALYs). Photodynamic therapy followed by surveillance for residual HGD was the most effective strategy, with a life expectancy of 12.31 QALYs, but it also resulted in the greatest lifetime cost ($47,310).

See "Cost-effectiveness of photodynamic therapy for high-grade dysplasia in Barrett's esophagus," by Dr. Vij, George Triadafilopoulos, M.D., Douglas K. Owens, M.D., M.S., and others, in Gastrointestinal Endoscopy 60(4), pp. 739-756, 2004.

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