OBJECTIVES:  To assess the cost-effectiveness of the introduction of endoscopic treatment with radiofrequency ablation (RFA) in the standard of care (SoC) of Barrett’s Oesophagus (BE) patients with high-grade dysplasia (HGD) or low-grade dysplasia (LGD) compared with SoC alone in Spain. METHODS:  A 15-year horizon semi-Markov model with six health states that reflected the natural disease progression was developed. An initial cohort of 65-year-old patients diagnosed with BE and HGD or LGD was modelled. Strategies compared were: endoscopic ablation treatment based on endoscopic mucosal resection (EMR) plus RFA added to SoC (based on endoscopic surveillance, esophagectomy or palliative chemoradiotherapy according to disease status) vs. SoC alone. Efficacies, transition probabilities and utilities were obtained from published literature. Clinical management patterns and resource use were determined according to Spanish clinical practice based on expert’s opinion. Spanish unitary costs were considered and expressed in euros of 2016. The National Health System (NHS) perspective was considered. An annual 3% discount rate was applied for costs and outcomes. Univariate and probabilistic sensitivity analyses were performed to test the robustness of the model. RESULTS:  In the base-case analysis, BE patients with LGD treated with initial EMR+RFA vs. SoC alone avoided 20.0%, 23.9% and 20.7% of esophagectomies, chemoradiotherapy and esophageal adenocarcinoma cases, respectively