The cost‐effectiveness of biomarkers for predicting the development of oesophageal adenocarcinoma

Rubenstein, Joel H.; Vakil, Nimish; Inadomi, John M.

doi:10.1111/j.1365-2036.2005.02536.x

Cited by 24 publications

(14 citation statements)

References 70 publications

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“…Future research including evaluation of genetic markers to determine cancer risk (31,32) and biomarkers of progression (33,34) may also permit selection of higher-risk groups for endoscopic surveillance or treatment. We make no recommendation to proceed with routine use of biomarkers in practice, but the adoption of these markers in specialist centers could be considered.…”

Section: Commentarymentioning

confidence: 99%

BOB CAT: a Large-Scale Review and Delphi Consensus for Management of Barrett’s Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia

Bennett

Moayyedi

Corley

et al. 2015

American Journal of Gastroenterology

126

121

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OBJECTIVES Barrett’s esophagus (BE) is a common premalignant lesion for which surveillance is recommended. This strategy is limited by considerable variations in clinical practice. We conducted an international, multidisciplinary, systematic search and evidence-based review of BE and provided consensus recommendations for clinical use in patients with nondysplastic, indefinite, and low-grade dysplasia (LGD). METHODS We defined the scope, proposed statements, and searched electronic databases, yielding 20,558 publications that were screened, selected online, and formed the evidence base. We used a Delphi consensus process, with an 80% agreement threshold, using GRADE (Grading of Recommendations Assessment, Development and Evaluation) to categorize the quality of evidence and strength of recommendations. RESULTS In total, 80% of respondents agreed with 55 of 127 statements in the final voting rounds. Population endoscopic screening is not recommended and screening should target only very high-risk cases of males aged over 60 years with chronic uncontrolled reflux. A new international definition of BE was agreed upon. For any degree of dysplasia, at least two specialist gastrointestinal (GI) pathologists are required. Risk factors for cancer include male gender, length of BE, and central obesity. Endoscopic resection should be used for visible, nodular areas. Surveillance is not recommended for <5 years of life expectancy. Management strategies for indefinite dysplasia (IND) and LGD were identified, including a de-escalation strategy for lower-risk patients and escalation to intervention with follow-up for higher-risk patients. CONCLUSIONS In this uniquely large consensus process in gastroenterology, we made key clinical recommendations for the escalation/de-escalation of BE in clinical practice. We made strong recommendations for the prioritization of future research.

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Section: Commentarymentioning

confidence: 99%

BOB CAT: a Large-Scale Review and Delphi Consensus for Management of Barrett’s Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia

Bennett

Moayyedi

Corley

et al. 2015

American Journal of Gastroenterology

126

121

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“…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].…”

Section: Overview Of Opportunity For Economic Evaluations To Inform Dmentioning

confidence: 99%

“…Perceived risk plays a role in adherence to recommended surveillance [32], so a tool that better defines risk could contribute to improved adherence. The high cost and limited effectiveness of BE surveillance combined with the benefits of early diagnosis and treatment of EAC create a substantial opportunity to improve cost-effectiveness by stratifying the risk of progression to cancer and targeting more intensive surveillance to those at high risk [27]. 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.…”

Section: Overview Of Opportunity For Economic Evaluations To Inform Dmentioning

confidence: 99%

“…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.…”

Section: Overview Of Opportunity For Economic Evaluations To Inform Dmentioning

confidence: 99%

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

Snyder¹,

Mitropoulou

Patrinos

et al. 2014

Public Health Genomics

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Evidence of the value of pharmacogenomic testing is needed to inform policymakers and clinicians for decision making related to adoption and coverage, and to facilitate prioritization for research and development. Pharmacogenomics has an important role in creating a more efficient healthcare system, and this article addresses how economic evaluation can strategically target evidence gaps for public health priorities with examples from pharmacogenomic medicine. This article begins with a review of the need for and use of economic evaluations in value-based decision making for pharmacogenomic testing. Three important gaps are described with examples demonstrating how they can be addressed: (1) projected impact of hypothetical new technology, (2) pre-implementation assessment of a specific technology, and (3) post-implementation assessment from relevant analytical stakeholder perspectives. Additional needs, challenges and approaches specific to pharmacogenomic economic evaluation in the developing world are also identified. These pragmatic approaches can provide much needed evidence to support real-world value-based decision making for pharmacogenomic-based screening and treatment strategies.

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“…Computer modeling suggests that a strategy of intensive surveillance guided by a novel biomarker would be more cost-effective than the current strategy of dysplasia-guided surveillance if the novel marker was as little as 80% sensitive and 80% specific for the progression to cancer [40]. A marker that is 95% specific for progression to cancer could be used to select patients for prophylactic esophagectomy.…”

Section: Novel Markers Of Risk Of Progressionmentioning

confidence: 99%

Screening for esophageal cancer and Barrett’s esophagus

Rubenstein¹,

Inadomi

2007

Curr GERD Rep

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The incidence of esophageal adenocarcinoma is rapidly increasing. Because endoscopically recognizing the associated premalignant condition (Barrett's esophagus) is feasible, many have recommended endoscopic screening and surveillance to decrease mortality from this cancer. However, such a strategy remains controversial, because it is impaired by poor ability to select high-risk patients for screening, limited ability to stratify patients on the risk of progression to cancer, and unproven efficacy for reducing mortality. This review summarizes the published guideline recommendations for screening and surveillance for esophageal adenocarcinoma, the limitations of such a strategy, and emerging progress toward a more rational, effective strategy for reducing mortality from this increasingly common and deadly cancer.

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The cost‐effectiveness of biomarkers for predicting the development of oesophageal adenocarcinoma

Cited by 24 publications

References 70 publications

BOB CAT: a Large-Scale Review and Delphi Consensus for Management of Barrett’s Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia

BOB CAT: a Large-Scale Review and Delphi Consensus for Management of Barrett’s Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia

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

Screening for esophageal cancer and Barrett’s esophagus

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