Researchers from New Mexico and Arizona, USA, assessed the cost-effectiveness of endoscopic surveillance for Barrett's esophagus every 2-5 years, for the detection of esophageal adenocarcinoma.
The incremental cost-effectiveness of surveillance (as compared to no surveillance) was analyzed with a computer model of a Markov process.
Compared to no surveillance, the incremental cost-effectiveness of biannual endoscopy was found to be $16,695 per life-year saved.
| Cost-effectiveness of biannual endoscopy: $16,695 per life-year saved.
| Alimentary Pharmacology & Therapeutics |
The researchers found that surveillance is less cost-effective if the incidence rate of esophageal adenocarcinoma is low and the 5-year survival rate is high.
For surveillance to be cost-effective there should be little reduction in health-related quality of life following surgical esophagectomy to prevent death.
Moreover, endoscopic surveillance and esophagectomy need to be efficacious in reliably diagnosing high-grade dysplasia and preventing deaths from cancer.
If such ideal conditions of surveillance are not met, the cost per life-year saved could rise 5-fold, the authors comment.
Dr A. Sonnenberg, of the Department of Veterans Affairs Medical Center, Albuquerque, New Mexico, concludes on behalf of the group, "Endoscopic surveillance of patients with Barrett's esophagus may be a cost-effective means to prevent death from esophageal adenocarcinoma."