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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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| Published in: | World journal of surgery 2017-04, Vol.41 (4), p.1023-1034 |
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| container_end_page | 1034 |
| container_issue | 4 |
| container_start_page | 1023 |
| container_title | World journal of surgery |
| container_volume | 41 |
| creator | 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. |
| description | 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 |
| doi_str_mv | 10.1007/s00268-016-3819-0 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_500864</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4319889651</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5438-71991e3f83537e598cc7c65dfef6949cea40f61c067ccd74b5065fc812d06f953</originalsourceid><addsrcrecordid>eNqNks1uEzEURi0EoqHwAGyQJTZsBq7H4z92NEqhKAhEi1hajscubpNxas8QKja8Bq_Hk-BR0hYhVbAaz9U5V1efPoQeE3hOAMSLDFBzWQHhFZVEVXAHTUhD66qmNb2LJkB5U96E7qEHOZ8BEMGB30d7tZCybgifoO8ncWNSi9_F5PDM-2CD63p8PKSvLiyXprMOR48PTEqu73_9-JnxLMf1F3M65Jf4qC1wKJLpQ-yw6Vo8-2aXQx7_ivahzAuRsenxPG7wx5DPx_l03JseonveLLN7tPvuo0-Hs5Ppm2r-_vXR9NW8sqyhshJEKeKol5RR4ZiS1grLWeud56pR1pkGPCcWuLC2Fc2CAWfeSlK3wL1idB9V271549bDQq9TWJl0qaMJejc6Ly-nGYDkTeHVrfw6xfZGuhIJZZwAYaK4z7ZuAS8Gl3u9Ctm6MUkXh6yJlEQwIhr-H2hDFeeSj-jTv9CzOKSuhFYowbiCEkShyJayKeacnL--nIAeC6O3hdGlMHosjIbiPNltHhYr114bVw25CWMTlu7y3xv157fHB4cga5DFrXdBFq07demPs2-96DcM4d2N</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1875690949</pqid></control><display><type>article</type><title>Toward More Efficient Surveillance of Barrett’s Esophagus: Identification and Exclusion of Patients at Low Risk of Cancer</title><source>Springer Nature</source><creator>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.</creator><creatorcontrib>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.</creatorcontrib><description>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 <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 ≥2 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.</description><identifier>ISSN: 0364-2313</identifier><identifier>ISSN: 1432-2323</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-016-3819-0</identifier><identifier>PMID: 27882416</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>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</subject><ispartof>World journal of surgery, 2017-04, Vol.41 (4), p.1023-1034</ispartof><rights>Société Internationale de Chirurgie 2016</rights><rights>2017 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>World Journal of Surgery is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5438-71991e3f83537e598cc7c65dfef6949cea40f61c067ccd74b5065fc812d06f953</citedby><cites>FETCH-LOGICAL-c5438-71991e3f83537e598cc7c65dfef6949cea40f61c067ccd74b5065fc812d06f953</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27882416$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:135610157$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Lindblad, Mats</creatorcontrib><creatorcontrib>Bright, Tim</creatorcontrib><creatorcontrib>Schloithe, Ann</creatorcontrib><creatorcontrib>Mayne, George C.</creatorcontrib><creatorcontrib>Chen, Gang</creatorcontrib><creatorcontrib>Bull, Jeff</creatorcontrib><creatorcontrib>Bampton, Peter A.</creatorcontrib><creatorcontrib>Fraser, Robert J. L.</creatorcontrib><creatorcontrib>Gatenby, Piers A.</creatorcontrib><creatorcontrib>Gordon, Louisa G.</creatorcontrib><creatorcontrib>Watson, David I.</creatorcontrib><title>Toward More Efficient Surveillance of Barrett’s Esophagus: Identification and Exclusion of Patients at Low Risk of Cancer</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>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 <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 ≥2 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.</description><subject>Abdominal Surgery</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Australia</subject><subject>Barrett Esophagus - pathology</subject><subject>Cardiac Surgery</subject><subject>Cell Transformation, Neoplastic</subject><subject>Cohort Studies</subject><subject>Cost-Benefit Analysis</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>General Surgery</subject><subject>Health risks</subject><subject>Humans</subject><subject>Index Endoscopy</subject><subject>Intestinal Metaplasia</subject><subject>Male</subject><subject>Medicin och hälsovetenskap</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Scientific Report</subject><subject>Precancerous Conditions - pathology</subject><subject>QALY Gain</subject><subject>Quality-Adjusted Life Years</subject><subject>Risk Assessment</subject><subject>Surgery</subject><subject>Surveillance Interval</subject><subject>Surveillance Program</subject><subject>Thoracic Surgery</subject><subject>Vascular Surgery</subject><subject>Watchful Waiting - economics</subject><issn>0364-2313</issn><issn>1432-2323</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNqNks1uEzEURi0EoqHwAGyQJTZsBq7H4z92NEqhKAhEi1hajscubpNxas8QKja8Bq_Hk-BR0hYhVbAaz9U5V1efPoQeE3hOAMSLDFBzWQHhFZVEVXAHTUhD66qmNb2LJkB5U96E7qEHOZ8BEMGB30d7tZCybgifoO8ncWNSi9_F5PDM-2CD63p8PKSvLiyXprMOR48PTEqu73_9-JnxLMf1F3M65Jf4qC1wKJLpQ-yw6Vo8-2aXQx7_ivahzAuRsenxPG7wx5DPx_l03JseonveLLN7tPvuo0-Hs5Ppm2r-_vXR9NW8sqyhshJEKeKol5RR4ZiS1grLWeud56pR1pkGPCcWuLC2Fc2CAWfeSlK3wL1idB9V271549bDQq9TWJl0qaMJejc6Ly-nGYDkTeHVrfw6xfZGuhIJZZwAYaK4z7ZuAS8Gl3u9Ctm6MUkXh6yJlEQwIhr-H2hDFeeSj-jTv9CzOKSuhFYowbiCEkShyJayKeacnL--nIAeC6O3hdGlMHosjIbiPNltHhYr114bVw25CWMTlu7y3xv157fHB4cga5DFrXdBFq07demPs2-96DcM4d2N</recordid><startdate>201704</startdate><enddate>201704</enddate><creator>Lindblad, Mats</creator><creator>Bright, Tim</creator><creator>Schloithe, Ann</creator><creator>Mayne, George C.</creator><creator>Chen, Gang</creator><creator>Bull, Jeff</creator><creator>Bampton, Peter A.</creator><creator>Fraser, Robert J. L.</creator><creator>Gatenby, Piers A.</creator><creator>Gordon, Louisa G.</creator><creator>Watson, David I.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope></search><sort><creationdate>201704</creationdate><title>Toward More Efficient Surveillance of Barrett’s Esophagus: Identification and Exclusion of Patients at Low Risk of Cancer</title><author>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.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5438-71991e3f83537e598cc7c65dfef6949cea40f61c067ccd74b5065fc812d06f953</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abdominal Surgery</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Australia</topic><topic>Barrett Esophagus - pathology</topic><topic>Cardiac Surgery</topic><topic>Cell Transformation, Neoplastic</topic><topic>Cohort Studies</topic><topic>Cost-Benefit Analysis</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>General Surgery</topic><topic>Health risks</topic><topic>Humans</topic><topic>Index Endoscopy</topic><topic>Intestinal Metaplasia</topic><topic>Male</topic><topic>Medicin och hälsovetenskap</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Scientific Report</topic><topic>Precancerous Conditions - pathology</topic><topic>QALY Gain</topic><topic>Quality-Adjusted Life Years</topic><topic>Risk Assessment</topic><topic>Surgery</topic><topic>Surveillance Interval</topic><topic>Surveillance Program</topic><topic>Thoracic Surgery</topic><topic>Vascular Surgery</topic><topic>Watchful Waiting - economics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lindblad, Mats</creatorcontrib><creatorcontrib>Bright, Tim</creatorcontrib><creatorcontrib>Schloithe, Ann</creatorcontrib><creatorcontrib>Mayne, George C.</creatorcontrib><creatorcontrib>Chen, Gang</creatorcontrib><creatorcontrib>Bull, Jeff</creatorcontrib><creatorcontrib>Bampton, Peter A.</creatorcontrib><creatorcontrib>Fraser, Robert J. L.</creatorcontrib><creatorcontrib>Gatenby, Piers A.</creatorcontrib><creatorcontrib>Gordon, Louisa G.</creatorcontrib><creatorcontrib>Watson, David I.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lindblad, Mats</au><au>Bright, Tim</au><au>Schloithe, Ann</au><au>Mayne, George C.</au><au>Chen, Gang</au><au>Bull, Jeff</au><au>Bampton, Peter A.</au><au>Fraser, Robert J. L.</au><au>Gatenby, Piers A.</au><au>Gordon, Louisa G.</au><au>Watson, David I.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Toward More Efficient Surveillance of Barrett’s Esophagus: Identification and Exclusion of Patients at Low Risk of Cancer</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2017-04</date><risdate>2017</risdate><volume>41</volume><issue>4</issue><spage>1023</spage><epage>1034</epage><pages>1023-1034</pages><issn>0364-2313</issn><issn>1432-2323</issn><eissn>1432-2323</eissn><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) ≥2 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 ≥2 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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>27882416</pmid><doi>10.1007/s00268-016-3819-0</doi><tpages>12</tpages></addata></record> |
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| ispartof | World journal of surgery, 2017-04, Vol.41 (4), p.1023-1034 |
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| source | Springer Nature |
| 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 |
| title | Toward More Efficient Surveillance of Barrett’s Esophagus: Identification and Exclusion of Patients at Low Risk of Cancer |
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