Cost-effectiveness of screening a population with chronic gastroesophageal reflux.
BACKGROUND
Persons with chronic esophageal reflux are at increased risk for the development of Barrett's esophagus and adenocarcinoma. Recently developed ultrathin endoscopes are less expensive and better tolerated than standard endoscopes, they can be used without sedation, and are sensitive and specific for Barrett's esophagus. The cost-effectiveness of one-time screening strategies were evaluated for 50-year-old patients with chronic reflux: no screening, standard endoscopy, and screening by an ultrathin endoscope.


METHODS
Markov models were created to simulate the clinical course for patients with chronic reflux. Costs and quality-adjusted life-years were estimated from cancer registry data, published medical data, and expert opinion.


RESULTS
Under baseline assumptions, no screening resulted in average costs of $11,785 per person and 19.3226 quality-adjusted life-years. Ultrathin endoscopy screening resulted in costs of $12,119 per person and 19.3326 quality-adjusted life-years, yielding a marginal cost-effectiveness ratio of $55,764 per quality-adjusted life-year. Using standard endoscopy yielded costs of $12,332 with only slightly greater effectiveness, yielding a marginal cost-effectiveness ratio of $709,260 when compared with ultrathin endoscopy and $86,833 compared with no screening. Results were most sensitive to variation in the incidence of cancer in the population with Barrett's esophagus.


CONCLUSIONS
Screening for Barrett's esophagus with ultrathin endoscopy is more cost-effective than standard endoscopy, and both strategies appear to improve quality-adjusted life-years among patients with chronic reflux at costs that are similar to those of other accepted preventive measures.
Nietert
Paul J
PJ
Center for Health Care Research, Medical University of South Carolina, Charleston, South Carolina, USA.
Silverstein
Marc D
MD
Mokhashi
Mahesh S
MS
Kim
Christopher Y
CY
Glenn
Tammy F
TF
Marsi
Vicki A
VA
Hawes
Robert H
RH
Wallace
Michael B
MB
D000230:Adenocarcinoma / Q000191:economics / Q000453:epidemiology*; D001471:Barrett Esophagus / Q000191:economics / Q000453:epidemiology*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D004938:Esophageal Neoplasms / Q000191:economics / Q000453:epidemiology*; D020701:Esophagoscopes; D004945:Esophagoscopy / Q000191:economics* / Q000379:methods; D005764:Gastroesophageal Reflux / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity