Cost-Effectiveness Analysis on Endoscopic Surveillance Among Western Patients With Barrett's Esophagus for Esophageal Adenocarcinoma Screening

Abstract

Incidence of esophageal adenocarcinoma (EAC) has risen rapidly over the past decades in Western countries. As a premalignant lesion, Barrett's esophagus (BE) is an established risk factor of EAC. This study estimated the impact of surveillance endoscopy for BE on population's survival upon EAC by a whole-population cost-effectiveness analysis among modeled Western population.Possibilities and survival payoffs were retrieved through literature searching based on PubMed database. Patients with BE were classified as adequate surveillance (AS), inadequate surveillance (IAS), and no surveillance groups. Direct cost of endoscopy per person-year was estimated from diagnosis of BE to before diagnosis of EAC in the whole-population model, whereas the payoff was 2-year disease-specific survival rate of EAC.AS for patients with BE had lower cost-effectiveness ratio (CER) than that of IAS group, as well as lower incremental cost-effectiveness ratio (6116 €/% vs 118,347 €/%). Prolonging the surveillance years could decrease the yearly cost in whole population and also relevant CERs, despite increased total cost. Increasing the proportion of participants in AS group could improve the survival benefit. The maximal payoff was up to 2-year mortality reduction of 2.7 per 100,000 persons by spending extra €1,658,913 per 100,000 person-years.A longer endoscopic surveillance among BE subpopulation plan can reduce yearly budget. Attempt to increase the proportion of AS participants can induce decline in population mortality of EAC, despite extra but acceptable expenditure. However, regarding optimal cost-effectiveness, further studies are still required to identify a high-risk subpopulation out of BE patients for endoscopic surveillance.

Evaluation of Serum Glycoprotein Biomarker Candidates for Detection of Esophageal Adenocarcinoma and Surveillance of Barrett's Esophagus

“…The significant cost of endoscopy plus the low annual progression rate to HGD or EAC means that the cost-effectiveness of endoscopic surveillance is questioned at the population level (13)(14)(15)(16).…”

Molecular biomarkers of progression from Barrett’s esophagus to esophageal adenocarcinoma

“…However, despite regular surveillance programs, the rates of OAC continue to rise (10,11). With the new role of endoscopic submucosal resection there is an increased clinical need to identify and prioritize high-risk individuals who will benefit from endoscopy and submucosal resection (2,8), which is a limited resource (12,13). A variety of biomarkers that have been associated with esophageal cancer have been proposed to aid in this risk stratification (9,14).…”

Cost-effectiveness of precision screening for esophageal cancer based on individualized risk stratification in China: Real-world evidence from the ESECC trial

“…Moreover, pathology-based surveillance has resulted in insufficient diagnosis or in missed SDA cases which had progressed ( 16 ). Precision screening strategies for ESCC based on efficient risk stratification are therefore needed to enable accurate identification of high-risk subgroups in target populations and to better facilitate the allocation of health resources ( 14 , 17 – 19 ).…”