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Cost-Effectiveness of Screening and Surveillance for Barrett Esophagus
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What is the problem and what is known about it so far?
In gastroesopahgeal reflux, stomach contents wash up into the esophagus, causing irritation and indigestion. Over time, GERD can lead to Barrett esophagus, in which intestinal lining replaces the normal lining of the esophagus. People with Barrett esophagus are at increased risk for cancer of the esophagus. The chances of cancer are greatest in patients with Barrett esophagus and dysplasia, a precancerous abnormality of the lining of the esophagus. To diagnose Barrett esophagus, doctors insert a tube with a small camera on the end through patients' mouths into the esophagus, a procedure called endoscopy. Some have proposed that patients with GERD should have endoscopy to screen for Barrett esophagus. Patients with Barrett esophagus would then have periodic endoscopy to find tumors when they are small and treatable. Since reflux is very common, this screening strategy could affect many people and be expensive.
Why did the researchers do this particular study?
To estimate the cost-effectiveness of several strategies of screening for Barrett esophagus.
Who was studied?
Rather than studying actual patients, the researchers used computers to simulate what would happen to a “virtual” group of 50-year-old men with GERD.
How was the study done?
The researchers used published information to estimate what might happen [and how much it would cost] if 50-year-old men with GERD had 1) no screening for Barrett esophagus, 2) screening with periodic endoscopy for patients with Barrett esophagus and no dysplasia, and 3) periodic screening only for patients with Barrett esophagus and dysplasia. They put these estimates into the computer model and calculated how much each strategy would cost per year of life that it saved.
What did the researchers find?
Compared to no screening, the costs of screening with periodic endoscopy of patients with Barrett esophagus and dysplasia were $10,440 per year of life saved. Screening and follow-up of patients without dysplasia every 5 years cost an additional $596,000 per year of life saved.
What were the limitations of the study?
The computer model considers only 50-year-old men, so the results might not apply to other types of patients. The study was a computer simulation, so we cannot be sure what the results would be with actual patients.
What are the implications of the study?
It appears reasonably cost-effective to screen 50-year-old men with GERD for Barrett esophagus, with periodic follow-up endoscopy to detect cancer only for those who have both Barrett esophagus and dysplasia.
Article and Author Information
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The summary below is from the full report titled “Screening and Surveillance for Barrett Esophagus in High-Risk Groups: A Cost–Utility Analysis.” It is in the 4 February 2003 issue of Annals of Internal Medicine (volume 138, pages 176-186). The authors are JM Inadomi, R Sampliner, J Lagergren, D Lieberman, AM Fendrick, and N Vakil.
- Copyright ©2004 by the American College of Physicians
