期刊
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
卷 35, 期 11, 页码 5905-5917出版社
SPRINGER
DOI: 10.1007/s00464-021-08646-0
关键词
Barrett's esophagus; Endoscopic surveillance; Cost-effectiveness; Incremental cost-effectiveness ratio
类别
资金
- Hospital Research Foundation
- Cancer Council of South Australia's Beat Cancer Project
- State Government of South Australia Department of Health
- Flinders Medical Centre Foundation
Studies revealed that guideline-specified endoscopic surveillance for patients with non-dysplastic Barrett's esophagus (NDBE) was not cost-effective. Instead, a strategy of deselecting low-risk NDBE patients from surveillance may be a cost-effective approach.
Background Individuals with Barrett's esophagus are believed to be at 30-120x risk of developing esophageal adenocarcinoma (EAC). Early detection and endoscopic treatment of dysplasia/early cancer confers a significant advantage to patients under surveillance; however, most do not progress past the non-dysplastic state of Barrett's esophagus (NDBE), which is potentially an inefficient distribution of health care resources. Objectives This article aimed to review the outcomes of cost-effectiveness studies reducing low-value care in the context of endoscopic surveillance for non-dysplastic Barrett's esophagus (NDBE). Methods A systematic search was conducted by two reviewers in accordance with PRISMA guidelines. Inclusion criteria: cost-utility analyses of endoscopic surveillance of NDBE patients with at least one treatment strategy focused on reduction of surveillance. A narrative synthesis of economic evaluations was undertaken, along with an in-depth analysis of input parameters contributing to stated Incremental cost-effectiveness ratios (ICER). Study appraisal was performed using the consolidated health economic evaluation reporting standards (CHEERS) tool. Results 10 Studies met inclusion criteria. There was significant variation in cost-model structures, input parameters, ICER values, and willingness-to-pay thresholds between studies. All studies except one concluded guideline-specified endoscopic surveillance for NDBE patients was not cost-effective. Studies that explored a modified surveillance by deselection of low-risk NDBE patients found it to be a cost-effective strategy. Conclusion Guideline specified endoscopic surveillance for NDBE was not found to be cost-effective in the studies examined. A modified endoscopic surveillance strategy removing individuals with the lowest risk for progression from NDBE to adenocarcinoma is likely to be cost-effective but is dependent on risk profile of patients excluded from surveillance.
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