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Cost effectiveness of endoscopic and nonendoscopic Cytosponge screening for Barrett's

This month's Gastroenterology examines health benefits and cost effectiveness of endoscopic and nonendoscopic Cytosponge screening for Barrett's esophagus.

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Dr Tatiana Benaglia and colleagues from the United Kingdom developed a model to compare the health benefits and cost effectiveness of screening for Barrett's esophagus by either Cytosponge™ or by conventional endoscopy vs no screening.

In addition, the team estimated the ability of the various methods to reduce mortality from esophageal adenocarcinoma.

The researchers used microsimulation modeling of a hypothetical cohort of 50-year-old men in the United Kingdom with histories of gastroesophageal reflux disease symptoms, assuming the prevalence of Barrett's esophagus to be 8%.

Participants were invited to undergo screening by endoscopy or Cytosponge, and outcomes were compared with those from men who underwent no screening.

Cytosponge screening results in a mean gain of 0.015 quality-adjusted life years
Gastroenterology

and her team of doctors estimated the number of incident esophageal adenocarcinoma cases prevented and the incremental cost-effectiveness ratio of quality-adjusted life years of the different strategies.

Patients found to have high-grade dysplasia or intramucosal cancer received endotherapy.

Supplementary and sensitivity analyses comprised esophagectomy management of high-grade dysplasia or intramucosal cancer, screening by ultrathin nasal endoscopy, and different assumptions of uptake of screening invitations for either strategy.

The researchers found that compared with no screening, Cytosponge screening followed by treatment of patients with dysplasia or intramucosal cancer costs an additional $240 per screening participant, and results in a mean gain of 0.015 quality-adjusted life years and an incremental cost-effectiveness ratio of $15,7000 per quality-adjusted life years .

The respective values for endoscopy were $299, 0.013 quality-adjusted life years, and $22.2K.

The researchers found that screening by the Cytosponge followed by treatment of patients with dysplasia or intramucosal cancer would reduce the number of cases of incident symptomatic esophageal adenocarcinoma by 19%, compared with 17% for screening by endoscopy.

The team noted that although this greater benefit for Cytosponge depends on more patients accepting screening by Cytosponge compared with screening by endoscopy.

Dr Benaglia and team concludes, "In a microsimulation model, screening 50-year-old men with symptoms of gastroesophageal reflux disease by Cytosponge is cost effective, and would reduce mortality from esophageal adenocarcinoma compared with no screening."

Gastroenterology 2013: 144(1): 62-73
11 January 2013

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