title: Cost-effectiveness of chemoprevention with proton pump inhibitors in Barrett's esophagus.
abstract: BACKGROUND
  Proton pump inhibitors (PPIs) may reduce the risk of esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus. PPIs are prescribed for virtually all patients with Barrett's esophagus, irrespective of the presence of reflux symptoms, and represent a de facto chemopreventive agent in this population. However, long-term PPI use has been associated with several adverse effects, and the cost-effectiveness of chemoprevention with PPIs has not been evaluated.
  
  
  OBJECTIVE
  The purpose of this study was to assess the cost-effectiveness of PPIs for the prevention of EAC in Barrett's esophagus without reflux.
  
  
  METHODS
  We designed a state-transition Markov microsimulation model of a hypothetical cohort of 50-year-old white men with Barrett's esophagus. We modeled chemoprevention with PPIs or no chemoprevention, with endoscopic surveillance for all treatment arms. Outcome measures were life-years, quality-adjusted life years (QALYs), incident EAC cases and deaths, costs, and incremental cost-effectiveness ratios.
  
  
  RESULTS
  Assuming 50% reduction in EAC, chemoprevention with PPIs was a cost-effective strategy compared to no chemoprevention. In our model, administration of PPIs cost $23,000 per patient and resulted in a gain of 0.32 QALYs for an incremental cost-effectiveness ratio of $12,000/QALY. In sensitivity analyses, PPIs would be cost-effective at $50,000/QALY if they reduce EAC risk by at least 19%.
  
  
  CONCLUSIONS
  Chemoprevention with PPIs in patients with Barrett's esophagus without reflux is cost-effective if PPIs reduce EAC by a minimum of 19%. The identification of subgroups of Barrett's esophagus patients at increased risk for progression would lead to more cost-effective strategies for the prevention of esophageal adenocarcinoma.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA, rzs9001@med.cornell.edu.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Freedberg
authors.forename: Julian A
authors.initials: JA
authors.lastname: Abrams
authors.forename: Y Claire
authors.initials: YC
authors.lastname: Wang
mesh_terms: D000230:Adenocarcinoma / Q000517:prevention & control*; D001471:Barrett Esophagus / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D004938:Esophageal Neoplasms / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008954:Models, Biological; D018803:Models, Economic; D054328:Proton Pump Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D014481:United States
chemical_list: D054328:Proton Pump Inhibitors