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

Abstract

Abstract,, , , Background:, Endoscopic! surveillance! for! nonVdysplastic! Barrett's! esophagus! is! contentious!and!its!costVeffectiveness!unclear.!!

Circulating Serum Exosomal miRNAs As Potential Biomarkers for Esophageal Adenocarcinoma

“…As outcomes are better when this cancer is treated early, endoscopy surveillance of individuals with the precursor Barrett's esophagus is undertaken to identify individuals who might benefit from early intervention. However, the annual rate of progression to cancer is reported to range from 0.12 to 0.4% [3], so the cost effectiveness of Barrett's esophagus surveillance has been questioned [4]. If less invasive detection tools such as a reliable blood test can be developed, then it might be possible to reduce dependence on endoscopy surveillance in high risk individuals, or more cost effective surveillance strategies might be developed.…”

Systematic Analysis and Critical Appraisal of the Quality of the Scientific Evidence and Conflicts of Interest in Practice Guidelines (2005–2013) for Barrett’s Esophagus

“…Interestingly, only two of the guidelines, the ASGE and BSG guidelines, provide recommendations for when it might be appropriate to discontinue screening if no dysplasia is found on repeat endoscopies [22,25]. While the ability to cure or heal Barrett's is still unknown, the overall cost-effectiveness of a surveillance program in patients without any dysplastic findings is less clear [41][42][43][44]. The concept of discontinuing surveillance is not without controversy but does have precedent.…”

Economic Evaluation of Pharmacogenomics: A Value-Based Approach to Pragmatic Decision Making in the Face of Complexity

“…Good candidate technologies include those targeted at improving patient outcomes and reducing costs through identification of which patients will benefit more from effective high-cost treatments or surveillance for diseases with high morbidity or mortality. An example of this early modeling approach is provided by 2 cost-effectiveness studies related to hypothetical testing technology for patient risk stratification of Barrett's esophagus (BE) to identify those at higher risk for developing esophageal cancer [27,28]. In the US, about two-thirds of new esophageal cancer cases are adenocarcinoma (EAC), with the remaining one-third being squamous cell carcinoma [29].…”

“…Two cost-effectiveness studies used Markov models to synthesize evidence on incidence, transition states (BE, dysplasia, cancer and death) and costs, and found hypothetical strategies to be cost-effective based on estimated US cost per quality-adjusted life year (QALY) ratios. The first study is for a theoretical marker for predicting the development of EAC [27], and the second is for a hypothetical biomarker-modified surveillance strategy [28]. The primary outcome for the first study was the threshold cost and performance characteristics needed for a biomarker to be more cost-effective than current practice.…”