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dc.contributor.authorGordon, Louisa
dc.contributor.authorC. Mayne, George
dc.contributor.authorHirst, Nick
dc.contributor.authorBright, Timothy
dc.contributor.authorC. Whiteman, David
dc.contributor.authorI. Watson, David
dc.date.accessioned2019-04-05T01:10:45Z
dc.date.available2019-04-05T01:10:45Z
dc.date.issued2014
dc.identifier.issn00165107en_US
dc.identifier.doi10.1016/j.gie.2013.07.046en_US
dc.identifier.urihttp://hdl.handle.net/10072/62069
dc.description.abstractBackground: Endoscopic surveillance for non-dysplastic Barrett's esophagus (BE) is contentious and its cost effectiveness unclear. Objective: To perform an economic analysis of endoscopic surveillance strategies. Design: Cost-utility analysis by using a simulation Markov model to synthesize evidence from large epidemiologic studies and clinical data for surveillance, based on international guidelines, applied in a coordinator-managed surveillance program. Setting: Tertiary care hospital, South Australia. Patients: A total of 2040 patient-years of follow-up. Intervention: (1) No surveillance, (2) 2-yearly endoscopic surveillance of patients with non-dysplastic BE and 6-monthly surveillance of patients with low-grade dysplasia, (3) a hypothetical strategy of biomarker-modified surveillance. Main Outcome Measurements: U.S. cost per quality-adjusted life year (QALY) ratios. Results: Compared with no surveillance, surveillance produced an estimated incremental cost per QALY ratio of $60,858. This was reduced to $38,307 when surveillance practice was modified by a hypothetical biomarker-based strategy. Sensitivity analyses indicated that the likelihood that surveillance alone was cost-effective compared with no surveillance was 16.0% and 60.6% if a hypothetical biomarker-based strategy was added to surveillance, at an acceptability threshold of $100,000 per QALY gained. Limitations: Treatment options for BE that overlap those for symptomatic GERD were omitted. Conclusion: By using best available estimates of the malignant potential of BE, endoscopic surveillance of patients with non-dysplastic BE is unlikely to be cost-effective for the majority of patients and depends heavily on progression rates between dysplasia grades. However, strategies that modify surveillance according to cancer risk might be cost-effective, provided that high-risk individuals can be identified and prioritized for surveillance.en_US
dc.description.peerreviewedYesen_US
dc.description.publicationstatusYesen_US
dc.format.extent575267 bytes
dc.format.mimetypeapplication/pdf
dc.languageEnglishen_US
dc.language.isoen_US
dc.publisherMosbyen_US
dc.publisher.placeUnited Statesen_US
dc.relation.ispartofstudentpublicationNen_US
dc.relation.ispartofpagefrom242en_US
dc.relation.ispartofpageto256en_US
dc.relation.ispartofissue2en_US
dc.relation.ispartofjournalGastrointestinal Endoscopyen_US
dc.relation.ispartofvolume79en_US
dc.rights.retentionYen_US
dc.subject.fieldofresearchMedical and Health Sciences not elsewhere classifieden_US
dc.subject.fieldofresearchcode119999en_US
dc.titleCost-effectiveness of endoscopic surveillance of non-dysplastic Barrett’s esophagusen_US
dc.typeJournal articleen_US
dc.type.descriptionC1 - Peer Reviewed (HERDC)en_US
dc.type.codeC - Journal Articlesen_US
gro.facultyGriffith Health, School of Medicineen_US
gro.rights.copyright© 2014 Elsevier Inc. This is the author-manuscript version of this paper. Reproduced in accordance with the copyright policy of the publisher. Please refer to the journal's website for access to the definitive, published versionen_US
gro.date.issued2014-10-13T02:09:41Z
gro.hasfulltextFull Text
gro.griffith.authorGordon, Louisa
gro.griffith.authorHirst, Nick


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