Original articleClinical endoscopyCost-effectiveness of endoscopic surveillance of non-dysplastic Barrett's esophagus
Section snippets
Description of strategies
Three strategies were modeled: (1) no surveillance, (2) endoscopic surveillance alone, and (3) endoscopic surveillance modified by a hypothetical biomarker test. Endoscopic surveillance intervals were based on U.K. British Society of Gastroenterology guidelines—2-yearly for non-dysplastic BE with intestinal metaplasia (IM) and 6-monthly for BE with low-grade dysplasia (LGD).22 It was assumed that appropriate scheduling of endoscopies was achieved, mucosal biopsy specimens were collected by
Results
Over 30 years, the (discounted) mean cost per person for the surveillance alone strategy was $14,659, compared with $11,087 for surveillance modified by a biomarker test and $5226 for no surveillance. The corresponding mean QALYs were 12.192 for surveillance alone, 12.190 for the strategy of surveillance with biomarker testing, and 12.037 for no surveillance. On average, the additional benefit for both surveillance strategies was equivalent to 57 additional days in good quality of life.
Discussion
Our results indicated that the surveillance alone strategy, as presented here, is unlikely to be cost effective when compared with no surveillance. This result is uncertain, however, because of the volatility in the model that results from small variations in the progression rates between dysplasia grades and the subsequent development of adenocarcinoma. However, the cost effectiveness was markedly improved under the hypothetical scenario of biomarker testing, with acceptable limits of
References (54)
- et al.
Barrett's oesophagus
Lancet
(2009) - et al.
Risk of esophageal adenocarcinoma and mortality in patients with Barrett's esophagus: a systematic review and meta-analysis
Clin Gastroenterol Hepatol
(2010) - et al.
Barrett's esophagus: development of dysplasia and adenocarcinoma
Gastroenterology
(1989) - et al.
The incidence of adenocarcinoma and dysplasia in Barrett's esophagus: report on the Cleveland Clinic Barrett's Esophagus Registry
Am J Gastroenterol
(1999) - et al.
Dysplasia and cancer in a large multicenter cohort of patients with Barrett's esophagus
Clin Gastroenterol Hepatol
(2006) - et al.
Barrett's esophagus: a new look at surveillance based on emerging estimates of cancer risk
Am J Gastroenterol
(1999) - et al.
Modeling the cost-effectiveness of strategies for treating esophageal adenocarcinoma and high grade dysplasia
J Gastrointest Surg
(2012) - et al.
Time trade-off derived EQ-5D weights for Australia
Value Health
(2011) - et al.
Cost-effectiveness model of endoscopic screening and surveillance in patients with gastroesophageal reflux disease
Clin Gastroenterol Hepatol
(2004) - et al.
Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice
Gastrointest Endosc
(1999)
Diagnostic inconsistencies in Barrett's esophagus. Department of Veterans Affairs Gastroesophageal Reflux Study Group
Gastroenterology
Does a surgical antireflux procedure decrease the incidence of esophageal adenocarcinoma in Barrett's esophagus? A meta-analysis
Am J Gastroenterol
Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus
Am J Gastroenterol
Receipt of previous diagnoses and endoscopy and outcome from esophageal adenocarcinoma: a population-based study with temporal trends
Am J Gastroenterol
Surveillance in Barrett's oesophagus: Will a strategy focused on a high-risk group reduce mortality from oesophageal adenocarcinoma?
Endoscopy
Risk of adenocarcinoma in Barrett's oesophagus: population based study
BMJ (Clinical Research Ed)
Audit of a Barrett's epithelium surveillance database
Eur J Gastroenterol Hepatol
An initial comparison of nine centres registering patients with the UK National Barrett's Oesophagus Registry (UKBOR)
Eur J Cancer Prev
Gastroesophageal reflux, Barrett esophagus, and esophageal cancer: scientific review
JAMA
Is endoscopic surveillance for non-dysplastic Barrett's esophagus cost-effective? Review of economic evaluations
J Gastroenterol Hepatol
An economic analysis of endoscopic ablative therapy for management of nondysplastic Barrett's esophagus
Endoscopy
Screening and surveillance for Barrett esophagus in high-risk groups: a cost-utility analysis
Ann Int Med
A cost-utility analysis of ablative therapy for Barrett's esophagus
Gastroenterology
A UK-based cost-utility analysis of radiofrequency ablation or oesophagectomy for the management of high-grade dysplasia in Barrett's oesophagus
Aliment Pharmacol Ther
Incidence of adenocarcinoma among patients with Barrett's esophagus
N Engl J Med
NSAIDs modulate CDKN2A, TP53, and DNA content risk for progression to esophageal adenocarcinoma
PLoS Med
Barrett's esophagus: a review of biology and therapeutic approaches
Gastrointest Cancer Res
Cited by (0)
DISCLOSURE: L. Gordon received support from an NHMRC Early Career Fellowship grant (no. 496714). D. Whiteman received funding from an Australian Research Council Future Fellowship. No other financial relationships relevant to this publication were disclosed.