Original ArticlesCost-effectiveness of screening a population with chronic gastroesophageal reflux☆,☆☆,★
Section snippets
Patients and methods
The cost-effectiveness (CE) analysis was designed to determine the average lifetime-costs and average lifetime quality-adjusted life-years (QALYs) associated with each of 3 strategies: no screening, screening with UTE, and screening with SE. In these analyses, all patients are assumed to have GERD, defined for the purposes of the study as heartburn and/or acid reflux at least once per week. For all strategies, patients identified as having BE with no or low-grade dysplasia are assumed to be in
Baseline scenario
The outcomes of modeling the 3 screening strategies are shown in Table 3.Under a strategy of no screening, the baseline assumptions used in the model indicate that 882 cases of esophageal adenocarcinoma would be expected over the lifetimes of 100,000 patients 50 years of age with GERD, with 266 cases having distant disease. Under the UTE strategy, only 431 cases of esophageal adenocarcinoma would be expected, with 26 cases of distant disease, and under the strategy of screening with SE, 396
Discussion
This study finds that screening patients with chronic GERD for BE is cost-effective and comparable with other commonly accepted medical procedures such as hemodialysis,24 screening for colorectal cancer,25 and mammography.7, 8, 26 Screening with UTE, which generally does not require sedation, is more cost effective than SE with sedation, despite the loss of some optical quality and the inability to obtain biopsy specimens.
Endoscopic screening of patients with GERD for BE and surveillance of
References (45)
- et al.
Endoscopic surveillance of Barrett's esophagus. Does it help?
J Thorac Cardiovasc Surg
(1993) - et al.
Prevalence of columnar-lined (Barrett's) esophagus. Comparison of population-based clinical and autopsy findings
Gastroenterology
(1990) Practice guidelines on the diagnosis, surveillance, and therapy of Barrett's esophagus. The Practice Parameters Committee of the American College of Gastroenterology
Am J Gastroenterol
(1998)- et al.
Barrett's esophagus: a new look at surveillance based on emerging estimates of cancer risk
Am J Gastroenterol
(1999) - et al.
Surveillance and survival in Barrett's adenocarcinomas: a population-based study
Gastroenterology
(2002) - et al.
Peroral ultrathin endoscopy in adult patients
Gastrointest Endosc
(1997) - et al.
Unsedated peroral endoscopy with a video ultrathin endoscope: patient acceptance, tolerance, and diagnostic accuracy
Am J Gastroenterol
(1998) - et al.
A randomized trial of peroral versus transnasal unsedated endoscopy using an ultrathin videoendoscope
Gastrointest Endosc
(1999) - et al.
Unsedated small-caliber esophagogastroduodenoscopy (EGD) versus conventional EGD: a comparative study
Gastroenterology
(1999) - et al.
Prospective evaluation of transnasal esophagogastroduodenoscopy: feasibility and study on performance and tolerance
Gastrointest Endosc
(1999)
A comparison of transnasal and transoral endoscopy with small-diameter endoscopes in unsedated patients
Gastrointest Endosc
A comparative study of unsedated transnasal esophagogastroduodenoscopy and conventional EGD
Gastrointest Endosc
Colorectal cancer screening: clinical guidelines and rationale
Gastroenterology
Screening for high-grade dysplasia in gastroesophageal reflux disease: is it cost-effective?
Am J Gastroenterol
Unsedated trans-nasal pharyngoesophagogastroduodenoscopy (T-EGD): technique
Gastrointest Endosc
Can a 3.1 mm stand-alone battery poweredesophagoscope screen the esophagus for esophagitis and Barrett's? A prospective blinded comparison with a standard videoendoscope
Gastrointest Endosc
Barrett's esophagus: development of dysplasia and adenocarcinoma
Gastroenterology
Barrett's esophagus: age, prevalence, and extent of columnar epithelium
Gastroenterology
Enhanced gastrointestinal diagnosis: light-scattering spectroscopy and optical coherence tomography
Gastrointest Endosc Clin N Am
Endoscopic detection of dysplasia in patients with Barrett's esophagus using light scattering spectroscopy
Gastroenterology
Screening for colorectal cancer with flexible sigmoidoscopy by nonphysician endoscopists
Am J Med
Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota
Gastroenterology
Cited by (57)
Prevalence of Barrett's esophagus and performance of societal screening guidelines in an unreferred primary care population of U.S. veterans
2021, Gastrointestinal EndoscopyCitation Excerpt :However, Barrett’s screening has direct healthcare costs (eg, cost of endoscopy, pathology, sedation, facility fees) and direct non-healthcare costs (eg, transportation and lost wages).26 Most studies that have found endoscopic screening to be cost-effective are based on only screening individuals with GERD, with costs ranging from $10,440 to $12,332 per quality-adjusted life-year gained.27-29 Performing an upper endoscopy for initial BE screening at the time of the first screening colonoscopy around age 50 has previously been proposed30; however, a cost-effectiveness study found this strategy required $95,559 per quality-adjusted life-year saved.31
Endoscopic Screening for Barrett's Esophagus and Esophageal Adenocarcinoma: Rationale, Candidates, and Challenges
2021, Gastrointestinal Endoscopy Clinics of North AmericaASGE guideline on screening and surveillance of Barrett's esophagus
2019, Gastrointestinal EndoscopyEndosheath ultrathin transnasal endoscopy is a cost-effective method for screening for Barrett's esophagus in patients with GERD symptoms
2019, Gastrointestinal EndoscopyCitation Excerpt :After this, patients will have endoscopic surveillance after 3, 6, and 12 months and thereafter annually. The design of the model was comparative to known cost-effectiveness models in the field.5,6,15 Because we used updated input data and new costs, we also performed a comparative analysis with the study of Benaglia et al,5 in which a sub-analysis also was performed with uTNE as the screening method in 50-year-old men with GERD.
Acceptability, Accuracy, and Safety of Disposable Transnasal Capsule Endoscopy for Barrett's Esophagus Screening
2019, Clinical Gastroenterology and HepatologyCitation Excerpt :This may reduce operator costs and increase access to future screening programs. TNE screening was also found to be more cost-effective than C-EGD screening with lower direct and indirect costs.3,22 This multicenter study had several strengths and limitations.
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Funded, in part, by a grant from the U.S. Office of Naval Research (No. N00014-99-1-0784) to the Medical University of South Carolina. Dr. Wallace was funded by the American Digestive Health Foundation (TAP Pharmaceutical Outcomes Research Award).
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Reprint requests: Paul J. Nietert, PhD, Center for Health Care Research, 135 Cannon St., Suite 403, P.O. Box 250837, Charleston, SC 29425.
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