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Toward More Efficient Surveillance of Barrett's Esophagus: Identification and Exclusion of Patients at Low Risk of Cancer.
Lindblad, Mats; Bright, Tim; Schloithe, Ann; Mayne, George C; Chen, Gang; Bull, Jeff; Bampton, Peter A; Fraser, Robert J L; Gatenby, Piers A; Gordon, Louisa G; Watson, David I.
  • Lindblad M; Department of Surgery, Flinders University, Flinders Medical Centre, Room 3D211, Bedford Park, Adelaide, SA, 5042, Australia.
  • Bright T; Division of Upper Gastrointestinal Surgery, Centre of Digestive Diseases, Karolinska, University Hospital, Stockholm, Sweden.
  • Schloithe A; Department of Surgery, Flinders University, Flinders Medical Centre, Room 3D211, Bedford Park, Adelaide, SA, 5042, Australia.
  • Mayne GC; Department of Surgery, Flinders University, Flinders Medical Centre, Room 3D211, Bedford Park, Adelaide, SA, 5042, Australia.
  • Chen G; Department of Surgery, Flinders University, Flinders Medical Centre, Room 3D211, Bedford Park, Adelaide, SA, 5042, Australia.
  • Bull J; Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia.
  • Bampton PA; Department of Surgery, Flinders University, Flinders Medical Centre, Room 3D211, Bedford Park, Adelaide, SA, 5042, Australia.
  • Fraser RJ; Department of Gastroenterology and Hepatology, Flinders University, Adelaide, Australia.
  • Gatenby PA; Department of Gastroenterology and Hepatology, Flinders University, Adelaide, Australia.
  • Gordon LG; Department of Surgery, Royal Surrey County Hospital, Guildford, UK.
  • Watson DI; Centre for Applied Health Economics, Griffith University, Brisbane, Australia.
World J Surg ; 41(4): 1023-1034, 2017 Apr.
Article en En | MEDLINE | ID: mdl-27882416
BACKGROUND: Endoscopic surveillance of Barrett's esophagus (BE) is probably not cost-effective. A sub-population with BE at increased risk of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) who could be targeted for cost-effective surveillance was sought. METHODS: The outcome for BE surveillance from 2003 to 2012 in a structured program was reviewed. Incidence rates and incidence rate ratios for developing HGD or EAC were calculated. Risk stratification identified individuals who could be considered for exclusion from surveillance. A health-state transition Markov cohort model evaluated the cost-effectiveness of focusing on higher-risk individuals. RESULTS: During 2067 person-years of follow-up of 640 patients, 17 individuals progressed to HGD or EAC (annual IR 0.8%). Individuals with columnar-lined esophagus (CLE) ≥2 cm had an annual IR of 1.2% and >8-fold increased relative risk of HGD or EAC, compared to CLE <2 cm [IR-0.14% (IRR 8.6, 95% CIs 4.5-12.8)]. Limiting the surveillance cohort after the first endoscopy to individuals with CLE ≥2 cm, or dysplasia, followed by a further restriction after the second endoscopy-exclusion of patients without intestinal metaplasia-removed 296 (46%) patients, and 767 (37%) person-years from surveillance. Limiting surveillance to the remaining individuals reduced the incremental cost-effectiveness ratio from US$60,858 to US$33,807 per quality-adjusted life year (QALY). Further restrictions were tested but failed to improve cost-effectiveness. CONCLUSIONS: Based on stratification of risk, the number of patients requiring surveillance can be reduced by at least a third. At a willingness-to-pay threshold of US$50,000 per QALY, surveillance of higher-risk individuals becomes cost-effective.
Asunto(s)

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Lesiones Precancerosas / Esófago de Barrett / Medición de Riesgo / Espera Vigilante Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País como asunto: Oceania Idioma: En Año: 2017 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Lesiones Precancerosas / Esófago de Barrett / Medición de Riesgo / Espera Vigilante Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País como asunto: Oceania Idioma: En Año: 2017 Tipo del documento: Article