Medical decision analysis of endoscopic surveillance of Barrett’s oesophagus to prevent oesophageal adenocarcinoma

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Abstract
Background: Barrett’s oesophagus is associated with an increased risk of the development of oesophageal adenocarcinoma. Endoscopic surveillance every 2–5 years has been recommended to prevent death from adenocarcinoma.Aim: To assess the cost‐effectiveness of this strategy.Methods: The incremental cost‐effectiveness of surveillance (as compared to no surveillance) was analysed with a computer model of a Markov process.Results: Compared to no surveillance, the incremental cost‐effectiveness of bi‐annual endoscopy is $16 695 per life‐year saved. Surveillance is less cost‐effective if the incidence rate of oesophageal adenocarcinoma is low and the 5‐year survival rate is high. For surveillance to be cost‐effective, there should be little reduction in health‐related quality of life following surgical oesophagectomy to prevent death. Moreover, endoscopic surveillance and oesophagectomy need to be efficacious in reliably diagnosing high‐grade dysplasia and preventing deaths from cancer. If such ideal conditions of surveillance are not met, the cost per life‐year saved could rise five‐fold.Conclusions: Endoscopic surveillance of patients with Barrett’s oesophagus may be a cost‐effective means to prevent death from oesophageal adenocarcinoma.

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