title: Surveillance in patients with long-segment Barrett's oesophagus: a cost-effectiveness analysis.
abstract: OBJECTIVE
  Surveillance is recommended for Barrett's oesophagus (BO) to detect early oesophageal adenocarcinoma (OAC). The aim of this study was to evaluate the cost-effectiveness of surveillance.
  
  
  METHODS
  We included 714 patients with long-segment BO in a multicentre prospective cohort study and used a multistate Markov model to calculate progression rates from no dysplasia (ND) to low-grade dysplasia (LGD), high-grade dysplasia (HGD) and OAC. Progression rates were incorporated in a decision-analytic model, including costs and quality of life data. We evaluated different surveillance intervals for ND and LGD, endoscopic mucosal resection (EMR), radiofrequency ablation (RFA) and oesophagectomy for HGD or early OAC and oesophagectomy for advanced OAC. The incremental cost-effectiveness ratio (ICER) was calculated in costs per quality-adjusted life-year (QALY).
  
  
  RESULTS
  The annual progression rate was 2% for ND to LGD, 4% for LGD to HGD or early OAC and 25% for HGD or early OAC to advanced OAC. Surveillance every 5 or 4 years with RFA for HGD or early OAC and oesophagectomy for advanced OAC had ICERs of €5.283 and €62.619 per QALY for ND. Surveillance every five to one year had ICERs of €4.922, €30.067, €32.531, €41.499 and €75.601 per QALY for LGD. EMR prior to RFA was slightly more expensive, but important for tumour staging.
  
  
  CONCLUSIONS
  Based on a Dutch healthcare perspective and assuming a willingness-to-pay threshold of €35.000 per QALY, surveillance with EMR and RFA for HGD or early OAC, and oesophagectomy for advanced OAC is cost-effective every 5 years for ND and every 3 years for LGD.
authors.affiliation: Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Kastelein
authors.affiliation: Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: van Olphen
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: E W
authors.initials: EW
authors.lastname: Steyerberg
authors.affiliation: Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Sikkema
authors.affiliation: Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: M C W
authors.initials: MC
authors.lastname: Spaander
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: C W N
authors.initials: CW
authors.lastname: Looman
authors.affiliation: Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuipers
authors.affiliation: Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: P D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Bruno
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: E W
authors.initials: EW
authors.lastname: de Bekker-Grob
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D001471:Barrett Esophagus / Q000453:epidemiology / Q000473:pathology* / Q000523:psychology; D017115:Catheter Ablation / Q000191:economics; D015984:Causality; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D042241:Early Diagnosis; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy / Q000191:economics; D004945:Esophagoscopy / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009367:Neoplasm Staging; D011159:Population Surveillance / Q000379:methods; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D011446:Prospective Studies; D011788:Quality of Life
keywords: BARRETT'S CARCINOMA; BARRETT'S METAPLASIA; BARRETT'S OESOPHAGUS; COST-EFFECTIVENESS; OESOPHAGEAL CANCER