title: Medical decision analysis of endoscopic surveillance of Barrett's oesophagus to prevent oesophageal adenocarcinoma.
abstract: 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.
authors.affiliation: Department of Veterans Affairs Medical Center and The University of New Mexico, Albuquerque, NM 87108, USA. sonnbrg@unm.edu
authors.forename: A
authors.initials: A
authors.lastname: Sonnenberg
authors.forename: A
authors.initials: A
authors.lastname: Soni
authors.forename: R E
authors.initials: RE
authors.lastname: Sampliner
mesh_terms: 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