Once-in-a-lifetime screening for Barrett's esophagus has been proposed for patients with gastroesophageal reflux disease (GERD). However, there is little evidence of its cost-effectiveness.
In this study, researchers from the United States sought to determined the cost-effectiveness of screening high-risk groups for Barrett's esophagus. They also determined the cost-effectiveness of providing surveillance to patients with both Barrett's esophagus and dysplasia, and all patients with Barrett's esophagus.
The team then compared these results with the cost-effectiveness of no screening or surveillance.
|Annual incidence of adenocarcinoma must exceed 1 case per 54 patient-years for surveillance of Barrett's esophagus without dysplasia.|
|Annals of Internal Medicine|
They compared no screening or surveillance, with screening and surveillance for Barrett's esophagus with dysplasia, or Barrett's esophagus without dysplasia, every 2 to 5 years.
In addition, low- or high-grade dysplasia received surveillance every 6 or 3 months, respectively.
The team's target population was 50-year-old white men with symptoms of GERD.
The team calculated the cost-effectiveness of screening the target population from 50 years of age, until 80 years of age or death.
The team found that screening with surveillance, limited to patients with Barrett's esophagus with dysplasia, required $10,440 per quality-adjusted life-year (QALY) saved, compared to no screening or surveillance.
In addition, the incremental cost-effectiveness ratio of surveillance every 5 years in patients with Barrett's esophagus without dysplasia, compared to surveillance of patients with Barrett's esophagus with dysplasia, was $596,000 per QALY saved.
The researchers determined that the annual incidence of adenocarcinoma must exceed 1 case per 54 patient-years of follow-up for surveillance of Barrett's esophagus without dysplasia, every 5 years to yield an incremental cost-effectiveness ratio less than $50,000 per QALY saved.
Dr John Inadomi's team concluded, "Screening 50-year-old men with symptoms of GERD to detect adenocarcinoma associated with Barrett's esophagus is probably cost-effective."
"However, subsequent surveillance of patients with Barrett's esophagus but no dysplasia, even at 5-year intervals, is an expensive practice."