Esophageal capsule endoscopy is a promising new technology for the detection of esophageal pathology.
Potential advantages for Barrett's esophagus screening include ability to return to work as a result of lack of intravenous sedation.
Drs Lauren Gerson and Otto Lin from California assessed lifetime costs and life expectancy for a cohort of 50-year old men with chronic gastroesophageal disease (GERD).
The team designed a Markov model to identify the presence of Barrett's esophagus.
|Upper endoscopy was associated with 19 life-years gained|
|Clinical Gastroenterology & Hepatology|
The team compared the base-case strategy of no screening for Barrett's esophagus with 2 competing screening strategies.
The first strategy included esophageal capsule endoscopy followed by upper endoscopy if Barrett's was suspected.
Within this strategy, esophageal capsule endoscopy was followed by upper endoscopy if there was poor visualization.
The second strategy was standard sedated endoscopy followed by upper endoscopy with biopsy.
The researchers obtained cost estimates from a third-party payer perspective.
For each strategy the team determined lifetime costs, life-years gained, and numbers of esophageal cancers detected.
The researchers also determined death rates from esophageal cancer, and procedural deaths.
The research team found that initial endoscopy followed by upper endoscopy was more expensive but more effective compared with the no screening strategy.
Assuming a theoretical cohort of 10,000 patients with GERD, initial endoscopy followed by upper endoscopy cost $1988.
The research team noted that it was associated with 19 life-years gained.
The team found that the cost for esophageal capsule endoscopy was $2392.
The use of esophageal capsule endoscopy was associated with 18 life-years gained.
For the no screening arm, the cost was $901 and was associated with 18 life-years gained.
The incremental cost-effectiveness ratio of screening with endoscopy followed by upper endoscopy compared with no screening was $4530 per life-year gained.
The model was robust to a wide range of sensitivity analyses.
Dr Gerson's team concluded, “Initial endoscopy followed by upper endoscopy appears more effective and less costly vs esophageal capsule endoscopy in patients with chronic GERD undergoing screening for Barrett's esophagus.”