Document Detail

Cost-effectiveness of endoscopic screening followed by surveillance for Barrett's esophagus: a review.
MedLine Citation:
PMID:  19840798     Owner:  NLM     Status:  MEDLINE    
Screening interventions for Barrett's esophagus (BE) are appealing, but there is little supporting evidence. We reviewed health economics studies about BE endoscopic screening followed by, as required, endoscopic surveillance ("screening and surveillance" hereafter) to help inform the design and conduct of future research. Health economics studies about BE screening and surveillance were identified using electronic database searches and personal contact with authors of identified studies. No studies examined general population screening. Five US studies published between 2003 and 2007 examined the cost effectiveness of screening and surveillance (against no intervention) in patients with chronic gastroesophageal reflux disease (GERD). There was no randomized trial evidence to inform model construction. Assumptions about prevalence and transition probabilities between BE histologic subtypes and about surveillance and treatment protocols varied substantially between studies. Parameters such as potential BE diagnosis-related reduction in quality of life or increase in health care use, diagnostic accuracy, and infrastructural costs (for quality assurance) were considered either "optimistically" or not at all. Only 2 studies considered endoscopic treatments. No study considered the recently introduced radiofrequency ablation technique, or the potential for biomarker-based risk stratification of surveillance interval or duration. Current health economics evidence is likely to have provided optimistic cost-effectiveness estimates and is not sufficient to support introduction of endoscopic BE screening programs among GERD patients. The evidence does not adequately incorporate novel (endoscopic) treatments and the potential for (clinical, endoscopic, or biomarker-based) risk stratification of surveillance. Future research should aim to encompass both these factors.
Josephine M Barbiere; Georgios Lyratzopoulos
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Publication Detail:
Type:  Journal Article; Review     Date:  2009-10-17
Journal Detail:
Title:  Gastroenterology     Volume:  137     ISSN:  1528-0012     ISO Abbreviation:  Gastroenterology     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-07     Completed Date:  2009-12-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1869-76     Citation Subset:  AIM; IM    
Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.
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MeSH Terms
Barrett Esophagus / diagnosis*,  economics,  etiology,  therapy
Chronic Disease
Cost-Benefit Analysis
Disease Progression
Esophagoscopy / economics*
Evidence-Based Medicine
Gastroesophageal Reflux / complications,  diagnosis*,  economics,  therapy
Health Care Costs
Markov Chains
Mass Screening / economics*,  methods
Models, Economic
Predictive Value of Tests
Research Design
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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