Cost-effectiveness of endoscopic surveillance of non-dysplastic Barrett's esophagus

摘要: Background Endoscopic surveillance for non-dysplastic Barrett's esophagus (BE) is contentious and its cost effectiveness unclear. Objective To perform an economic analysis of endoscopic strategies. Design Cost-utility by using a simulation Markov model to synthesize evidence from large epidemiologic studies clinical data surveillance, based on international guidelines, applied in coordinator-managed program. Setting Tertiary care hospital, South Australia. Patients A total 2040 patient-years follow-up. Intervention (1) No (2) 2-yearly patients with BE 6-monthly low-grade dysplasia, (3) hypothetical strategy biomarker-modified surveillance. Main Outcome Measurements U.S. per quality-adjusted life year (QALY) ratios. Results Compared no produced estimated incremental QALY ratio $60,858. This was reduced $38,307 when practice modified biomarker-based strategy. Sensitivity analyses indicated that the likelihood alone cost-effective compared 16.0% 60.6% if added at acceptability threshold $100,000 gained. Limitations Treatment options overlap those symptomatic GERD were omitted. Conclusion By best available estimates malignant potential BE, unlikely be majority depends heavily progression rates between dysplasia grades. However, strategies modify according cancer risk might cost-effective, provided high-risk individuals can identified prioritized