Introduction The BSG have recently risk stratified Barrett’s Oesophagus (BO) according to length of the BO segment and the presence of intestinal metaplasia (IM). Previously the recommendation was for a surveillance gastroscopy every two years. The surveillance interval recommended by the new guidelines1 now reflects the risk of developing adenocarcinoma. We aimed to quantify the potential cost saving of the implementation of the new BO surveillance guidelines.
Methods Patients with an endoscopic diagnosis BO were identified from endoscopy database records at our unit between 2009 and 2012. BO segment length was available and the presence of IM in the biopsy samples was retrievable from histology records. We allocated our patients into three groups: The 1st was those with a BO segment <3 cm and no IM (not needing further surveillance), the 2nd was those with a BO segment <3 cm with IM (now needing surveillance every 5 years) and the 3rd were those with a BO segment of 3cm or greater (needing surveillance every 3 years). The cost of a surveillance gastroscopy is estimated to be £5202 and our histopathology department advised that the cost of four quadrant biopsies was £65 (surveillance cost therefore being greater for those with longer BO segments). We first calculated the projected cost of surveillance over the next 10 years under the old guidelines. From this we subtracted the projected cost of surveillance for this period under the new guidelines.
Results 463 patients were identified who had an endoscopic diagnosis of BO. Sixty patients were excluded due to lack of data on BO length/IM.
The ten year projected cost saving for our trust by implementing the new BO surveillance guidelines was £754,260 (£75,426 per annum). There are over 150 hospital trusts in the UK that have endoscopy units, therefore even a conservative estimate is that the new BO guidelines will save the NHS in excess of £100 million in the next 10 years.
Conclusion New guidelines on BO surveillance will mean fewer surveillance gastroscopies need to be performed in the future. As well as giving the patients a better experience, these guidelines will result in a significant cost saving to our hospital and the NHS in general.
Fitzgerald R, di Pietro M, Ragunath K, et al. British society of gastroenterology guidelines on the management of Barrett’s oesophagus. Gut published online October 28:2013
Broe M, Barry M, Patchett S, Hill AD. Evaluating the clinical efficacy and cost effectiveness of direct access endoscopy. Surgeon 2013 Dec;11(6):304–8
Disclosure of Interest None Declared.