Surveillance of Barrett's oesophagus: is it worthwhile?
OBJECTIVE
To assess the cost-effectiveness of surveillance of Barrett's oesophagus.


METHODS
Cost-utility model.


METHODS
UK NHS.


METHODS
One thousand 55-year-old men with Barrett's oesophagus.


METHODS
Surveillance programme: endoscopy and biopsy at 3 yearly intervals for non-dysplastic Barrett's oesophagus; low-grade dysplasia yearly; high grade-dysplasia 3 monthly.


METHODS
Incremental cost-effectiveness ratio, expected value of perfect information.


RESULTS
Non-surveillance dominated surveillance (i.e. cost less and conferred more benefit), but there was substantial uncertainty around many of the model inputs. Probabilistic analyses showed that non-surveillance cost less and conferred more benefit in 75% of model runs. Surveillance was cost-effective at usual levels of willingness to pay in 11% of runs. For people with Barrett's oesophagus in England and Wales, a value of pound6.5 million is placed on acquiring perfect information about surveillance of Barrett's oesophagus.


CONCLUSIONS
The PenTAG cost-utility model suggests that surveillance programmes do more harm than good.
Somerville
M
M
Peninsula College of Medicine and Dentistry, C308, Portland Square, University of Plymouth, Drake's Circus, Plymouth PL4 8AA, UK. Margaret.somerville@pms.ac.uk
Garside
R
R
Pitt
M
M
Stein
K
K
D001471:Barrett Esophagus / Q000175:diagnosis* / Q000191:economics; D003362:Cost-Benefit Analysis; D004938:Esophageal Neoplasms / Q000191:economics*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic