dc.contributor.author | Lindblad, Mats | |
dc.contributor.author | Bright, Timothy | |
dc.contributor.author | Schloithe, Ann | |
dc.contributor.author | C. Mayne, George | |
dc.contributor.author | Chen, Gang | |
dc.contributor.author | Bull, Jeff | |
dc.contributor.author | Bampton, Peter A. | |
dc.contributor.author | Fraser, Robert J. L. | |
dc.contributor.author | Gatenby, Piers A. | |
dc.contributor.author | Gordon, Louisa | |
dc.contributor.author | Watson, David I. | |
dc.date.accessioned | 2017-11-28T12:01:12Z | |
dc.date.available | 2017-11-28T12:01:12Z | |
dc.date.issued | 2017 | |
dc.identifier.issn | 0364-2313 | |
dc.identifier.doi | 10.1007/s00268-016-3819-0 | |
dc.identifier.uri | http://hdl.handle.net/10072/339634 | |
dc.description.abstract | Background: 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.peerreviewed | Yes | |
dc.language | English | |
dc.language.iso | eng | |
dc.publisher | Springer New York | |
dc.relation.ispartofpagefrom | 1023 | |
dc.relation.ispartofpageto | 1034 | |
dc.relation.ispartofissue | 4 | |
dc.relation.ispartofjournal | World Journal of Surgery | |
dc.relation.ispartofvolume | 41 | |
dc.subject.fieldofresearch | Clinical Sciences not elsewhere classified | |
dc.subject.fieldofresearch | Clinical Sciences | |
dc.subject.fieldofresearchcode | 110399 | |
dc.subject.fieldofresearchcode | 1103 | |
dc.title | Toward More Efficient Surveillance of Barrett's Esophagus: Identification and Exclusion of Patients at Low Risk of Cancer | |
dc.type | Journal article | |
dc.type.description | C1 - Articles | |
dc.type.code | C - Journal Articles | |
gro.hasfulltext | No Full Text | |
gro.griffith.author | Gordon, Louisa | |