Document Detail

Screening for high-grade dysplasia in gastroesophageal reflux disease: is it cost-effective?
MedLine Citation:
PMID:  10950062     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The present study aimed to assess the cost-effectiveness of endoscopic screening in patients with gastroesophageal reflux disease (GERD) to rule out high-grade dysplasia of Barrett's esophagus. METHODS: Using an incremental cost-effectiveness ratio as outcome measure, the cost-effectiveness of endoscopic screening was compared to not screening in a decision tree. It was assumed that GERD patients at age 60 yr undergo a one-time endoscopy with esophageal biopsies, targeting abnormal-appearing epithelium. Positive biopsies with respect to high-grade dysplasia or early esophageal adenocarcinoma result in esophagectomy. Transition rates were estimated from U.S. cancer statistics, as well as published data of endoscopic sensitivity, specificity, and surgical outcome. Costs of screening and cancer care were estimated from Medicare reimbursement data from the perspective of a third-party-payor. RESULTS: Compared with no screening, screening endoscopy cost $24,700 per life-year saved. The cost-effectiveness of screening is quite sensitive to the prevalence of Barrett's esophagus, high-grade dysplasia, and adenocarcinoma, as well as the sensitivity, specificity, and cost of screening endoscopy. A small drop in the health-related quality of life associated with postsurgical states markedly reduced the effectiveness of screening. Simultaneous variations of the prevalence, specificity, and health-related quality of life can easily change screening endoscopy from a life-saving into a life-losing strategy. CONCLUSIONS: Under favorable conditions, general screening by endoscopy of all patients with reflux symptoms to prevent death from esophageal adenocarcinoma may represent a cost-effective strategy; however, such conditions may be difficult to meet.
A Soni; R E Sampliner; A Sonnenberg
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  95     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2000 Aug 
Date Detail:
Created Date:  2000-08-30     Completed Date:  2000-08-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2086-93     Citation Subset:  IM    
The Department of Veterans Affairs Medical Center and The University of New Mexico, Albuquerque, USA.
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MeSH Terms
Cost-Benefit Analysis
Decision Trees
Esophagus / pathology*
Gastroesophageal Reflux / pathology*
Health Care Costs*
Middle Aged
Multivariate Analysis
Sensitivity and Specificity
Stomach / pathology*

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