OBJECTIVES: Current guidelines for the management of patients with Barrett’s esophagus (BE) with high grade dysplasia recommend radiofrequency ablation (RFA) as a treatment, based upon demonstrated clinical and cost-effectiveness. For patients with BE with low grade dysplasia (LGD), in contrast, the mainstay of management is surveillance endoscopy. The aims of this study were to estimate whether RFA is cost-effective for patients with Barrett’s LGD compared to surveillance and to determine which factors influence the cost-effectiveness.  METHODS: A cost-utility analysis was undertaken.  A state transition Markov model was developed to estimate the costs and benefits of using RFA compared to surveillance in LGD.  All direct medical costs were estimated from the perspective of the Australian health care system with adjustments for the US health care system. The model was run for the lifetime of the cohort of patients where quality of life differed by disease state.  The incremental cost per quality adjusted life year (QALY) was estimated and uncertainty was explored using sensitivity analyses.  RESULTS: Clinical evidence suggests that RFA is superior in treating LGD compared to surveillance. Replacing surveillance with RFA would yield an additional benefit of 0.129 QALYs. However the cost-effectiveness of RFA is highly uncertain.  The main drivers of the cost-effectiveness results are the effectiveness of RFA, the probability of progression to cancer, and the cost of RFA.  CONCLUSIONS: The available data suggest that active treatment with RFA provides significantly better clinical outcomes than surveillance, but the cost-effectiveness of RFA in this patient group remains highly uncertain. RFA is not cost-effective if the low estimates of cancer risk for LGD from recent population-based studies are used, but the accuracy of these estimates is unclear. Accurate estimates of the risk of developing cancer in patients with no dysplasia or LGD are needed to conduct valid and reliable cost-effectiveness analyses.