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dc.contributor.authorLindblad, Mats
dc.contributor.authorBright, Timothy
dc.contributor.authorSchloithe, Ann
dc.contributor.authorC. Mayne, George
dc.contributor.authorChen, Gang
dc.contributor.authorBull, Jeff
dc.contributor.authorBampton, Peter A.
dc.contributor.authorFraser, Robert J. L.
dc.contributor.authorGatenby, Piers A.
dc.contributor.authorGordon, Louisa
dc.contributor.authorWatson, David I.
dc.date.accessioned2017-11-28T12:01:12Z
dc.date.available2017-11-28T12:01:12Z
dc.date.issued2017
dc.identifier.issn0364-2313
dc.identifier.doi10.1007/s00268-016-3819-0
dc.identifier.urihttp://hdl.handle.net/10072/339634
dc.description.abstractBackground: Endoscopic surveillance of Barrett’s esophagus (BE) is probably not cost-effective. A sub-population with BE at increased risk of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) who could be targeted for cost-effective surveillance was sought. Methods: The outcome for BE surveillance from 2003 to 2012 in a structured program was reviewed. Incidence rates and incidence rate ratios for developing HGD or EAC were calculated. Risk stratification identified individuals who could be considered for exclusion from surveillance. A health-state transition Markov cohort model evaluated the cost-effectiveness of focusing on higher-risk individuals. Results: During 2067 person-years of follow-up of 640 patients, 17 individuals progressed to HGD or EAC (annual IR 0.8%). Individuals with columnar-lined esophagus (CLE) C2 cm had an annual IR of 1.2% and[8-fold increased relative risk of HGD or EAC, compared to CLE \2 cm [IR—0.14% (IRR 8.6, 95% CIs 4.5–12.8)]. Limiting the surveillance cohort after the first endoscopy to individuals with CLE C2 cm, or dysplasia, followed by a further restriction after the second endoscopy—exclusion of patients without intestinal metaplasia—removed 296 (46%) patients, and 767 (37%) person-years from surveillance. Limiting surveillance to the remaining individuals reduced the incremental cost-effectiveness ratio from US$60,858 to US$33,807 per quality-adjusted life year (QALY). Further restrictions were tested but failed to improve cost-effectiveness. Conclusions: Based on stratification of risk, the number of patients requiring surveillance can be reduced by at least a third. At a willingness-to-pay threshold of US$50,000 per QALY, surveillance of higher-risk individuals becomes cost-effective
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherSpringer New York
dc.relation.ispartofpagefrom1023
dc.relation.ispartofpageto1034
dc.relation.ispartofissue4
dc.relation.ispartofjournalWorld Journal of Surgery
dc.relation.ispartofvolume41
dc.subject.fieldofresearchClinical Sciences not elsewhere classified
dc.subject.fieldofresearchClinical Sciences
dc.subject.fieldofresearchcode110399
dc.subject.fieldofresearchcode1103
dc.titleToward More Efficient Surveillance of Barrett's Esophagus: Identification and Exclusion of Patients at Low Risk of Cancer
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
gro.hasfulltextNo Full Text
gro.griffith.authorGordon, Louisa


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