Cost-benefit analysis of capsule endoscopy compared with standard upper endoscopy for the detection of Barrett's esophagus.
OBJECTIVE
Esophageal capsule endoscopy (ECE) is a promising new technology for the detection of esophageal pathology. Potential advantages for Barrett's esophagus (BE) screening include ability to return to work as a result of lack of intravenous sedation.


METHODS
We designed a Markov model to compare lifetime costs and life expectancy for a cohort of 50-year old men with chronic GERD for the presence of BE. We compared the base-case strategy of no screening for BE to 2 competing screening strategies: (1) ECE followed by upper endoscopy (EGD) if BE were suspected or if there was poor visualization on the ECE; and (2) standard sedated EGD with biopsy. Cost estimates were obtained from a third-party payer perspective. For each strategy we determined lifetime costs, life-years gained, numbers of esophageal cancers detected, death rates from esophageal cancer, and procedural deaths.


RESULTS
Initial EGD was more expensive but more effective compared with the no screening strategy. Assuming a theoretical cohort of 10,000 patients with GERD, initial EGD cost $1988 and was associated with 18.54 life-years compared with $2392 and 18.36 life-years for the ECE arm and $901 and 18.30 life-years for the no screening arm. The incremental cost-effectiveness ratio of screening with EGD compared with the no screening arm was $4530 per life-year gained. The model was robust to a wide range of sensitivity analyses.


CONCLUSIONS
Initial EGD appears more effective and less costly compared with ECE under base-case conditions for patients with chronic GERD undergoing screening for BE.
Gerson
Lauren
L
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California 94305-5202, USA. lgerson@stanford.edu
Lin
Otto S
OS
D000230:Adenocarcinoma / Q000517:prevention & control; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000453:epidemiology*; D053704:Capsule Endoscopy / Q000191:economics*; D002908:Chronic Disease; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004938:Esophageal Neoplasms / Q000517:prevention & control; D004945:Esophagoscopy / Q000191:economics*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis