Is endoscopic surveillance for non-dysplastic Barrett's esophagus cost-effective? Review of economic evaluations

Hirst, Nicholas G., Gordon, Louisa G., Whiteman, David C., Watson, David I. and Barendregt, Jan J. (2011) Is endoscopic surveillance for non-dysplastic Barrett's esophagus cost-effective? Review of economic evaluations. Journal of Gastroenterology and Hepatology, 26 2: 247-254. doi:10.1111/j.1440-1746.2010.06506.x


Author Hirst, Nicholas G.
Gordon, Louisa G.
Whiteman, David C.
Watson, David I.
Barendregt, Jan J.
Title Is endoscopic surveillance for non-dysplastic Barrett's esophagus cost-effective? Review of economic evaluations
Journal name Journal of Gastroenterology and Hepatology   Check publisher's open access policy
ISSN 0815-9319
1440-1746
Publication date 2011-02
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1111/j.1440-1746.2010.06506.x
Volume 26
Issue 2
Start page 247
End page 254
Total pages 8
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2012
Language eng
Formatted abstract
Background and Aim: Several health economic evaluations have explored the costeffectiveness of endoscopic surveillance for patients with non-dysplastic Barrett’s esophagus, with conflicting results. By comparing results across studies and highlighting key methodological and data limitations a platform for future, more rigorous analyses, can be developed.

Methods: A systematic literature review was undertaken of studies evaluating cost effectiveness of surveillance for non-dysplastic Barrett’s esophagus. Articles were included if they assessed both cost and health outcomes for surveillance versus no surveillance. A descriptive review was undertaken and the quality of the studies appraised against bestpractice recommendations for economic evaluations and modeling studies.

Results: Seven publications met the inclusion criteria. All used decision-analytic Markov models. Half of the evaluations found surveillance was not cost-effective. At best, surveillance produced improved outcomes at a cost of US$16 640 per quality- adjusted life-year, and at worst it did more harm than good and at a greater cost. The quality of the evaluations and generalizability to the Asia-Pacific region was diminished as a result of inadequate or inconsistent evidence supporting parameter estimates, such as quality of life, endoscopic sensitivity and specificity and cancer recurrence rates.

Conclusions:
Unless newly emerging technologies improve the quality-adjusted survival benefit conferred by endoscopic surveillance, this strategy is unlikely to be cost-effective. Obsolete assumptions and incomplete analyses reduce the quality of published evaluations. For these reasons new evaluations are required that encompass the growing evidence base for new technologies, such as new endoscopic therapies for high-grade dysplasia and intramucosal cancer.
Keyword Barrett esophagus
cost-benefit analysis
esophageal neoplasms
population surveillance
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2012 Collection
School of Public Health Publications
 
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