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Oct 2010 - Apr 2022

Economic evaluation of endoscopic ultrasound in gastro-oesophageal cancer staging: Exploring novel methodology in QALY estimations alongside clinical trials in the UK


Seow Tien Yeo



Funding Amount



Professor Rhiannon Tudor-Edwards

Cancer Type


Funding Type




Research Type

Cancer Control, survivorship and outcomes research


Tien explored whether endoscopic ultrasound, a medical diagnostic tool, for gastro-oesophageal cancer staging is good value for money and its current practice in the UK.

In addition, Tien also explored a new methodology looking into advancing the common unit “The quality-adjusted life year (QALY)”, a generic measure of disease burden, including both the quality and the quantity of life lived. One QALY equates to one year in perfect health used in health economic evaluation and is believed that it will help inform health policy in a more holistic approach.


The study showed that endoscopic ultrasound improves gastro-oesophageal patients’ (quality-adjusted) survival, in other words, it offers greater quality-adjusted-life-years (QALYs), and saves NHS costs.

The chance of endoscopic ultrasounds being cost-effective (value for money) at the UK NICE threshold of £20,000 per QALY gain is high – above 96%.

Clinicians that ‘attend Upper GI cancer MDT meeting’ was shown to be the most important factor associated with referral of gastro-oesophageal patients for EUS. Most UK gastro-oesophageal clinicians, who took part in the survey, recognised the value of endoscopic ultrasound for gastro-oesophageal staging, particularly in staging oesophageal and gastro-oesophageal junction cancers compared to gastric cancer. Increased MDT meeting attendance is likely to increase endoscopic ultrasound referral; hence, it is recommended that ‘attend MDT meeting’ be made mandatory as part of hospital protocol in clinical practice for all gastro-oesophageal clinicians to avoid unnecessary treatment in patients.

From the Tien’s exploratory study, it was found that incorporating disease-specific measures into QALY estimations yielded refined QALYs which are more appropriately reflect the ‘real’ status of patient’s quality of life compared to conventional QALYs that are measured solely by generic health-related quality of life instrument such as the European-Quality of life-5-Dimensions (EQ-5D) questionnaire.


Gastro-oesophageal cancer patients will continue be given access to Endoscopic Ultrasound staging where appropriate, as per the NICE Guidelines and it is also recommended that endoscopic ultrasound be made available more widely across the hospitals in the UK to avoid delays in the diagnosis and treatment planning of gastro-oesophageal cancers.

Next Steps

The next step is to expand the exploratory research work to a wider range of disease areas to get a clearer picture and conclusive findings in relation to using refined QALY for cost-utility analysis in clinical trial.

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