[Recommended endoscopic surveillance of patients with Barrett's esophagus (BE) is a cost-effective strategy?].
OBJECTIVE
Evaluate the cost-effectiveness of the American College of Gastroenterology (ACG) guidelines for the surveillance of Barrett's esophagus (BE) in the context of a Mexican cohort of patients with BE and no dysplasia.


BACKGROUND
For patients with BE and no dysplasia, the ACG has recommended endoscopic surveillance every three years. The cost-benefit of this strategy has been evaluated in populations with an annual incidence of esophageal adenocarcinoma (EA) of 1%-5%.


METHODS
Demographic, clinical, surveillance and disease progression characteristics were analysed in patients with BE and no dysplasia seen at a terciary care center. Four surveillance strategies were considered, namely endoscopy every one, two, three and four years. Direct medical cost of endoscopy was dollar 2,950.00 Mexican pesos (dollar 256.52 USD). Total costs, cost-effectiveness ratios and marginal costs were determined assuming a cohort of 100 BE patients followed for a period of 10 years.


RESULTS
A cohort of 185 BE patients was incepted, with a male:female ratio of 1.28:1, mean age of 55.14 years and mean follow-up of 7.1 years. Annual progression rate from no dysplasia to high grade dysplasia and AE was 0.30%. The lowest cost-effectiveness ratio was observed with endoscopic surveillance every five years, with a cost of dollar 202,913.86 Mexican pesos (dollar 17,644.68 USD) per high grade dysplasia and AE diagnosed.


CONCLUSIONS
In Mexican patients with BE and no dysplasia, progression to high grade dysplasia and AE is lower than reported. This makes the performance of endoscopy every five years a more cost-effective surveillance strategy in our environment.
Remes-Troche
José María
JM
Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, DF. chemaremes@hotmail.com
Ramírez-Arias
Juan Francisco
JF
Gómez-Escudero
Octavio
O
Valdovinos-Andraca
Francisco
F
Vargas-Vorácková
Florencia
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D003362:Cost-Benefit Analysis; D004938:Esophageal Neoplasms / Q000517:prevention & control; D004945:Esophagoscopy / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011230:Precancerous Conditions / Q000175:diagnosis / Q000191:economics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity