The Optimal Age to Stop Endoscopic Surveillance of Patients With Barrett's Esophagus Based on Sex and Comorbidity: A Comparative Cost-Effectiveness Analysis.
The Optimal Age to Stop Endoscopic Surveillance of Patients With Barrett's Esophagus Based on Sex and Comorbidity: A Comparative Cost-Effectiveness Analysis.
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基于性别和合并症的Barrett食管患者的最佳年龄以停止内窥镜监测：比较成本效益分析。
DOI：
10.1053/j.gastro.2021.05.003
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发表时间：
2021-08
期刊：
影响因子：
29.4
通讯作者：
Lansdorp-Vogelaar I
中科院分区：
文献类型：
--
作者：
Omidvari AH;Hazelton WD;Lauren BN;Naber SK;Lee M;Ali A;Seguin C;Kong CY;Richmond E;Rubenstein JH;Luebeck GE;Inadomi JM;Hur C;Lansdorp-Vogelaar I
目前的指南建议监测非发育异常巴雷特食管（NDBE）患者，但不包括建议停止监测的年龄。本研究旨在确定按性别和合并症水平分层的NDBE患者末次监测的最佳年龄。我们使用3个独立开发的模型来模拟诊断为NDBE的患者，这些患者的年龄、性别和合并症水平不同（无、轻度、中度和重度）。所有患者都接受了定期监测，直到他们目前的年龄。我们计算了在当前年龄时额外进行1次内镜监测与在该年龄时不进行监测的增量成本和质量调整生命年（Qs）。我们确定了结束监测的最佳年龄，即再进行1次监测的增量成本-效果比刚好低于10万美元/QALY的支付意愿阈值的年龄。多进行1次监测内镜检查的获益主要取决于年龄、性别和合并症。对于患有NDBE和重度合并症的男性，在80岁时进行1次额外监测，每1000例BE患者增加4次QOLS，额外费用为120万美元，而对于患有重度合并症的女性，该年龄的获益为7次QOLS，费用为130万美元。对于无、轻度、中度和重度合并症的男性，最佳末次监测年龄分别为81岁、80岁、77岁和73岁。对于女性来说，这些年龄更小：分别为75岁，73岁，73岁和69岁。我们的比较模型分析说明了在决定停止监测NDBE患者的年龄时，考虑合并症状态和性别的重要性。
Current guidelines recommend surveillance for patients with nondysplastic Barrett’s esophagus (NDBE) but do not include a recommended age for discontinuing surveillance. This study aimed to determine the optimal age for last surveillance of NDBE patients stratified by sex and level of comorbidity. We used 3 independently developed models to simulate patients diagnosed with NDBE, varying in age, sex, and comorbidity level (no, mild, moderate, and severe). All patients had received regular surveillance until their current age. We calculated incremental costs and quality-adjusted life-years (QALYs) gained from 1 additional endoscopic surveillance at the current age versus not performing surveillance at that age. We determined the optimal age to end surveillance as the age at which incremental cost-effectiveness ratio of 1 more surveillance was just less than the willingness-to-pay threshold of $100,000/QALY. The benefit of having 1 more surveillance endoscopy strongly depended on age, sex, and comorbidity. For men with NDBE and severe comorbidity, 1 additional surveillance at age 80 years provided 4 more QALYs per 1000 patients with BE at an additional cost of $1.2 million, whereas for women with severe comorbidity the benefit at that age was 7 QALYs at a cost of $1.3 million. For men with no, mild, moderate, and severe comorbidity, the optimal ages of last surveillance were 81, 80, 77, and 73 years, respectively. For women, these ages were younger: 75, 73, 73, and 69 years, respectively. Our comparative modeling analysis illustrates the importance of considering comorbidity status and sex when deciding on the age to discontinue surveillance in patients with NDBE.
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影响因子：
24.5
作者：
Fitzgerald, Rebecca C.;di Pietro, Massimiliano;de Caestecker, John
通讯作者：
de Caestecker, John
DOI：
10.1093/jnci/djh039
发表时间：
2004-02-18
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Hur, C;Nishioka, NS;Gazelle, GS
通讯作者：
Gazelle, GS
影响因子：
7.7
作者：
Gordon, Louisa G.;Mayne, George C.;Watson, David I.
通讯作者：
Watson, David I.
影响因子：
4.3
作者：
Gatenby, Piers;Caygill, Christine;Winslet, Marc
通讯作者：
Winslet, Marc
影响因子：
29.4
作者：
Kroep, Sonja;Lansdorp-Vogelaar, Iris;van Ballegooijen, Marjolein
通讯作者：
van Ballegooijen, Marjolein