Screening and surveillance for Barrett esophagus in high-risk groups: A cost-utility analysis
Screening and surveillance for Barrett esophagus in high-risk groups: A cost-utility analysis
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DOI：
10.7326/0003-4819-138-3-200302040-00009
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发表时间：
2003-02-04
影响因子：
39.2
通讯作者：
Vakil, N
中科院分区：
文献类型：
--
作者：
Inadomi, JM;Sampliner, R;Vakil, N
背景资料：针对胃食管反流病（GERD）患者，建议终生进行一次Barrett食管筛查，但其成本效益的证据很少。目的：1）确定筛查Barrett食管高危人群并对Barrett食管和异型增生患者或所有Barrett食管患者进行监测的成本效益，2）将结果与成本进行比较-设计：开发了一个决策分析模型，以检查没有筛查或监测，以及每2至5年筛查和监测仅伴异型增生的Barrett食管或不伴异型增生的Barrett食管。低度或高度异型增生分别每6个月或3个月接受一次监测。数据来源：已发表文献和卫生保健融资管理局。目标人群：50岁有GERD症状的白色男性。时间范围：50岁至80岁或死亡。视角：第三方付款人。结局指标：增量成本效益比。基础病例分析结果：与不进行筛查或监测相比，仅限于Barrett食管伴异型增生患者的筛查和监测需要每质量调整生命年（QALY）节省10 440美元。与Barrett食管伴异型增生患者的监测相比，每5年对无异型增生的Barrett食管患者进行监测的增量成本效益比为每节省QALY 596 000美元。敏感性分析结果：腺癌的年发病率必须超过1例/54患者-年随访（1.9%）每5年监测一次Barrett食管无异型增生，每挽救一个QALY，增量成本效果比低于50000美元。筛查50岁男性GERD症状，以检测与Barrett食管相关的腺癌可能具有成本效益。然而，对Barrett食管但无异型增生的患者进行后续监测，即使间隔5年，也是一种昂贵的做法。
Background: Once-in-a-lifetime screening for Barrett esophagus has been proposed for patients with gastroesophageal reflux disease (GERD) but there is little evidence of its cost-effectiveness.Objective: 1) To determine the cost-effectiveness of screening high-risk groups for Barrett esophagus and providing surveillance to patients with Barrett esophagus and dysplasia or to all patients With Barrett esophagus and 2) to compare the results with the cost-effectiveness of no screening or surveillance.Design: A decision analytic model was developed to examine no screening or surveillance and screening and surveillance for Barrett esophagus with dysplasia only or Barrett esophagus without dysplasia every 2 to 5 years. Low- or high-grade dysplasia received surveillance every 6 or 3 months, respectively.Data Sources: Published literature and the Health Care Financing Administration.Target Population: 50-year-old white men with symptoms of GERD.Time Horizon: 50 years of age until 80 years of age or death.Perspective: Third-party payer.Outcome Measure: incremental cost-effectiveness ratio.Results of Base-Case Analysis: Screening with surveillance limited to patients with Barrett esophagus with dysplasia required $10 440 per quality-adjusted life-year (QALY) saved compared to no screening or surveillance. The incremental cost-effectiveness ratio of surveillance every 5 years in patients with Barrett esophagus without dysplasia compared to surveillance of patients with Barrett esophagus with dysplasia was $596 000 per QALY saved.Results of Sensitivity Analysis: The annual incidence of adenocarcinoma must exceed 1 case per 54 patient-years of follow-up (1.9%) foe surveillance of Barrett esophagus without dysplasia every 5 years to yield an incremental cost-effectiveness ratio less than $50 000 per QALY saved.Conclusions: Screening 50-year-old men with symptoms of GERD to detect adenocarcinoma associated with Barrett esophagus is probably cost-effective. However, subsequent surveillance of patients with Barrett esophagus but no dysplasia, even at 5-year intervals, is an expensive practice.