Cost utility of screening for Barrett's esophagus with esophageal capsule endoscopy versus conventional upper endoscopy.
OBJECTIVE
Screening for Barrett's esophagus with conventional esophagoduodenoscopy (EGD) is recommended to decrease mortality from esophageal adenocarcinoma. Esophageal capsule endoscopy (ECE) has recently been shown to be accurate in detecting Barrett's esophagus. We aimed to compare the cost-effectiveness of screening by ECE with screening by EGD.


METHODS
A Markov model of 50-year-old white men with symptoms of gastroesophageal reflux was constructed to compare screening modalities. The model incorporated direct medical costs and indirect costs of lost productivity and followed the patients until age 80 years or death. Outcomes were analyzed from the societal perspective.


RESULTS
EGD screening prevented 60% of cancer deaths at a cost of $11,254 per quality-adjusted life year gained compared with no screening. ECE prevented 53% of cancer deaths and provided 9 fewer quality-adjusted days at greater cost than EGD. If society were only willing to pay $50,000 per quality-adjusted life year gained, then capsule screening would be preferred if the income of the patient and driver were each greater than $280,682. Otherwise, the findings were robust to all sensitivity analyses.


CONCLUSIONS
Screening for Barrett's esophagus with either EGD or ECE results in similar outcomes, but EGD is the preferred strategy. Both strategies appear cost-effective, and the model does not take into account patient preferences for screening modality or adherence.
Rubenstein
Joel H
JH
Division of Gastroenterology, University of Michigan Medical School, and the Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan 48105, USA. jhr@umich.edu
Inadomi
John M
JM
Brill
Joel V
JV
Eisen
Glenn M
GM
D000230:Adenocarcinoma / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001471:Barrett Esophagus / Q000175:diagnosis / Q000453:epidemiology*; D053704:Capsule Endoscopy / Q000191:economics* / Q000379:methods; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004938:Esophageal Neoplasms / Q000517:prevention & control; D004945:Esophagoscopy / Q000191:economics* / Q000379:methods; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D016019:Survival Analysis