Defining a clinically significant adverse impact of diagnosing Barrett's esophagus.
BACKGROUND
Diagnosing a potentially life-threatening disease may adversely affect patient quality of life (QOL) independent of biologic effects. It is unknown whether the mere diagnosis of Barrett's esophagus (BE) adversely impacts patients' preferences (health-state utility) sufficiently to impair the cost-effectiveness of endoscopic screening for esophageal adenocarcinoma.


OBJECTIVE
To calculate the threshold impact on utility incurred by diagnosing BE that would allow screening to remain cost-effective.


METHODS
A Markov model was developed to examine strategies of no screening, and screening with surveillance of BE. Patients were 50-year-old white men with symptoms of gastroesophageal reflux followed until 80 years of age or death. The primary outcomes were the threshold decrements in utility incurred by diagnosing BE based on willingness to pay (WTP) of dollar 50,000 and dollar 100,000 per quality-adjusted life-year (QALY) gained.


RESULTS
For a WTP of dollar 50,000/QALY, the decrement in utility could be as great as 9%, meaning that screening is cost-effective as long as diagnosing BE does not impair QOL by more than 9%. For a WTP of dollar 100,000, the decrement could be as great as 10.5%.


CONCLUSIONS
The decrement in utility caused by diagnosing BE may be substantial without compromising the cost-effectiveness of endoscopic screening.
Rubenstein
Joel H
JH
Division of Gastroenterology, University of Michigan Health System and Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI 48105, USA. jhr@umich.edu
Inadomi
John M
JM
D000230:Adenocarcinoma / Q000175:diagnosis* / 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* / Q000209:etiology; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening; D008875:Middle Aged; D011159:Population Surveillance; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000209:etiology; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity