Cost considerations in implementing a screening and surveillance strategy for Barrett's oesophagus

Best Practice & Research. Clinical Gastroenterology
John M Inadomi

Abstract

There is increasing concern over the rising costs of healthcare leading to debate regarding the use of resources to implement preventive strategies. Oesophageal adenocarcinoma and its precursor, Barrett's oesophagus provides an excellent opportunity to highlight this issue since cancer is uncommon even among individuals with documented Barrett's oesophagus. This review provides a brief introduction to economic analysis in healthcare and summarizes published studies of the cost-effectiveness of strategies to reduce mortality from cancer. Current best estimates highlight the cost-effectiveness of endoscopic ablation among patients with Barrett's oesophagus and high-grade dysplasia and the low cost-effectiveness of ablation among patients without dysplasia. The cost-effectiveness of ablation among patients with Barrett's and low-grade dysplasia is poorly defined due to the ambiguity of diagnosing dysplasia, the unknown risk of cancer among patients with low-grade dysplasia, and the uncertain durability of ablation to maintain remission from metaplasia and dysplasia and prevent cancer.

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Citations

Aug 26, 2016·Journal of Neurogastroenterology and Motility·Christian LottrupAsbjørn M Drewes
Jan 25, 2017·The American Journal of Gastroenterology·Sravanthi Parasa, Prateek Sharma
Nov 24, 2017·Revista Española De Enfermedades Digestivas : Organo Oficial De La Sociedad Española De Patología Digestiva·José Miguel EstebanSuzan Serip
Jun 16, 2018·Digestive Diseases and Sciences·Ernst J Kuipers, Manon C Spaander
Jun 28, 2018·Digestive Diseases and Sciences·John M Inadomi, Nina Saxena
May 14, 2020·F1000Research·James Franklin, Janusz Jankowski

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