Medical decision analysis of endoscopic surveillance of Barrett's oesophagus to prevent oesophageal adenocarcinoma.
BACKGROUND
Barrett's oesophagus is associated with an increased risk of the development of oesophageal adenocarcinoma. Endoscopic surveillance every 2-5 years has been recommended to prevent death from adenocarcinoma.


OBJECTIVE
To assess the cost-effectiveness of this strategy.


METHODS
The incremental cost-effectiveness of surveillance (as compared to no surveillance) was analysed with a computer model of a Markov process.


RESULTS
Compared to no surveillance, the incremental cost-effectiveness of bi-annual endoscopy is 16,695 dollars per life-year saved. Surveillance is less cost-effective if the incidence rate of oesophageal 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 oesophagectomy to prevent death. Moreover, endoscopic surveillance and oesophagectomy 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 five-fold.


CONCLUSIONS
Endoscopic surveillance of patients with Barrett's oesophagus may be a cost-effective means to prevent death from oesophageal adenocarcinoma.
Sonnenberg
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Department of Veterans Affairs Medical Center and The University of New Mexico, Albuquerque, NM 87108, USA. sonnbrg@unm.edu
Soni
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Sampliner
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D000230:Adenocarcinoma / Q000191:economics* / Q000209:etiology / Q000517:prevention & control*; D001471:Barrett Esophagus / Q000150:complications* / Q000191:economics / Q000473:pathology; D003362:Cost-Benefit Analysis; D020000:Decision Support Systems, Clinical; D003937:Diagnosis, Differential; D004724:Endoscopy / Q000191:economics*; D004938:Esophageal Neoplasms / Q000191:economics* / Q000209:etiology / Q000517:prevention & control*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011788:Quality of Life; D016019:Survival Analysis