Screening and surveillance for Barrett esophagus in high-risk groups: a cost-utility analysis.
BACKGROUND
Once-in-a-lifetime screening for Barrett esophagus has been proposed for patients with gastroesophageal reflux disease (GERD), but there is little evidence of its cost-effectiveness.


OBJECTIVE
1) To determine the cost-effectiveness of screening high-risk groups for Barrett esophagus and providing surveillance to patients with Barrett esophagus and dysplasia or to all patients with Barrett esophagus and 2) to compare the results with the cost-effectiveness of no screening or surveillance.


METHODS
A decision analytic model was developed to examine no screening or surveillance and screening and surveillance for Barrett esophagus with dysplasia only or Barrett esophagus without dysplasia every 2 to 5 years. Low- or high-grade dysplasia received surveillance every 6 or 3 months, respectively.


METHODS
Published literature and the Health Care Financing Administration.


METHODS
50-year-old white men with symptoms of GERD.


METHODS
50 years of age until 80 years of age or death.


CONCLUSIONS
Third-party payer.


METHODS
Incremental cost-effectiveness ratio.


RESULTS
Screening with surveillance limited to patients with Barrett esophagus with dysplasia required $10 440 per quality-adjusted life-year (QALY) saved compared to no screening or surveillance. The incremental cost-effectiveness ratio of surveillance every 5 years in patients with Barrett esophagus without dysplasia compared to surveillance of patients with Barrett esophagus with dysplasia was $596 000 per QALY saved.


RESULTS
The annual incidence of adenocarcinoma must exceed 1 case per 54 patient-years of follow-up (1.9%) for surveillance of Barrett esophagus without dysplasia every 5 years to yield an incremental cost-effectiveness ratio less than $50 000 per QALY saved.


CONCLUSIONS
Screening 50-year-old men with symptoms of GERD to detect adenocarcinoma associated with Barrett esophagus is probably cost-effective. However, subsequent surveillance of patients with Barrett esophagus but no dysplasia, even at 5-year intervals, is an expensive practice.
Inadomi
John M
JM
Veterans Affairs Ann Arbor Health Systems, 2215 Fuller Road, Ann Arbor, MI 48105, USA.
Sampliner
Richard
R
Lagergren
Jesper
J
Lieberman
David
D
Fendrick
A Mark
AM
Vakil
Nimish
N
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000209:etiology; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D004947:Esophagus / Q000473:pathology; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D009010:Monte Carlo Method; D011159:Population Surveillance; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000209:etiology; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity