Robert Enns, MD recommends this original article from the February issue “Cost-effectiveness of endoscopic surveillance of non-dysplastic Barrett’s esophagus” by Louisa G. Gordon, PhD, George C. Mayne, PhD, Nicholas G. Hirst, MHealthEcon, Timothy Bright, MBBS, PhD, David C. Whiteman, MBBS, PhD, for the Australian Cancer Study Clinical Follow-Up Study, and David I. Watson, MBBS, PhD.
This article adds to our understanding regarding the cost-benefit of surveying patients with Barrett’s esophagus for the development of dysplasia. The authors assess 3 different strategies in the cost effectiveness Markov model including no endoscopic surveillance vs q2 year endoscopic evaluation vs use of biomarkers. They conclude that endoscopic evaluation every 2 years results in a incremental cost per QALY of over $60,000. The use of biomarkers was favorable and suggested to be an alternative that would be more cost-effective.
Figure 1. Model schematic.
Although cost effectiveness studies are hypothetical and rely on many assumptions, there is still evidence that as a community in GI we need to carefully select our patients for endoscopic procures and try to maximize the benefit of these procedures to each patient.
As cost constraints become more prevalent, ensuring priorities for endoscopic services are mandatory, and determining which services are supported may be guided by costing studies such as this. Trying to maximize the benefits of each and every procedure to ensure appropriate use of resources should be an underlying theme for all of the GI community. This study helps us determine the most appropriate way to do this in the setting of Barrett’s surveillance.
Find this article on page 242-256 of the print journal or read the abstract online.
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