The Impact of the Policy-Practice Gap on Costs and Benefits of Barrett's Esophagus Management.
The Impact of the Policy-Practice Gap on Costs and Benefits of Barrett's Esophagus Management.
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DOI：
10.14309/ajg.0000000000000578
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发表时间：
2020-07
期刊：
影响因子：
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通讯作者：
Lansdorp-Vogelaar I
中科院分区：
文献类型：
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作者：
Omidvari AH;Roumans CAM;Naber SK;Kroep S;Wijnhoven BPL;Gaast AV;de Jonge PJ;Spaander MCW;Lansdorp-Vogelaar I
Clinical guidelines recommend surveillance of Barrett’s esophagus (BE) patients. However, the surveillance intervals in practice are shorter than policy recommendations. We aimed to determine how this policy-practice gap affects the costs and benefits of BE surveillance. We used The Netherlands as an exemplary Western country and simulated a cohort of 60-year-old BE patients using the MISCAN-EAC microsimulation model. We evaluated surveillance according to the Dutch guideline, as well as more intensive surveillance of non-dysplastic BE (NDBE) and low-grade dysplasia (LGD) patients. For each strategy, we computed the quality-adjusted life years (QALYs) gained and costs compared with no surveillance. We also performed a budget impact analysis to estimate the increased costs of BE management in The Netherlands for 2017. Compared with no surveillance, the Dutch guideline incurred an additional €5.0 ($5.7) million per 1,000 BE patients for surveillance and treatment, while 57 esophageal adenocarcinoma (EAC) cases (>T1a) were prevented. With intensive and very intensive surveillance strategies for both NDBE and LGD, the net costs increased by another €2.5–5.6 ($2.8–6.5) million, while preventing 10–19 more EAC cases and gaining 33–60 more QALYs. On a population level, this amounted to €21–47 ($24–54) million (+32–70%) higher healthcare costs in 2017. The policy-practice gap in BE surveillance intervals results in 50–114% higher net costs for BE management for only 10–18% increase in QALYs gained, depending on actual intensity of surveillance. Incentives to eliminate this policy-practice gap should be developed to reduce the burden of BE management on patients and healthcare resources.
