Toward More Efficient Surveillance of Barrett’s Esophagus: Identification and Exclusion of Patients at Low Risk of Cancer

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 surv...

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Bibliographic Details
Published in:World journal of surgery 2017-04, Vol.41 (4), p.1023-1034
Main Authors: Lindblad, Mats, Bright, Tim, Schloithe, Ann, Mayne, George C., Chen, Gang, Bull, Jeff, Bampton, Peter A., Fraser, Robert J. L., Gatenby, Piers A., Gordon, Louisa G., Watson, David I.
Format: Article
Language:English
Subjects:
Abdominal Surgery
Aged
Aged, 80 and over
Australia
Barrett Esophagus - pathology
Cardiac Surgery
Cell Transformation, Neoplastic
Cohort Studies
Cost-Benefit Analysis
Female
Follow-Up Studies
General Surgery
Health risks
Humans
Index Endoscopy
Intestinal Metaplasia
Male
Medicin och hälsovetenskap
Medicine
Medicine & Public Health
Middle Aged
Original Scientific Report
Precancerous Conditions - pathology
QALY Gain
Quality-Adjusted Life Years
Risk Assessment
Surgery
Surveillance Interval
Surveillance Program
Thoracic Surgery
Vascular Surgery
Watchful Waiting - economics
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Summary: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) ≥2 cm had an annual IR of 1.2% and >8-fold increased relative risk of HGD or EAC, compared to CLE
ISSN:0364-2313
1432-2323
1432-2323
DOI:10.1007/s00268-016-3819-0