Barrett's oesophagus - A review of costs of the illness

Citation
Mr. Arguedas et Ma. Eloubeidi, Barrett's oesophagus - A review of costs of the illness, PHARMACOECO, 19(10), 2001, pp. 1003-1011
Citations number
25
Categorie Soggetti
Pharmacology
Journal title
PHARMACOECONOMICS
ISSN journal
11707690 → ACNP
Volume
19
Issue
10
Year of publication
2001
Pages
1003 - 1011
Database
ISI
SICI code
1170-7690(2001)19:10<1003:BO-ARO>2.0.ZU;2-M
Abstract
Barrett's oesophagus is a premalignant complication that occurs in approxim ately 10% of patients with gastro-oesophageal reflux disease (GORD). In pat ients with Barrett's oesophagus, the risk of adenocarcinoma of the oesophag us approaches 0.5% per patient-years. Therefore, practice guidelines have b een developed that suggest screening patients with GORD, particularly those with long-standing symptoms and those aged greater than or equal to 50 yea rs for the presence of Barrett's metaplasia. These guidelines also suggest per-forming surveillance endoscopy for the development of dysplasia and/or cancer in patients found to harbour Barrett's oesophagus at initial screeni ng with the frequency of subsequent endoscopies dictated by the presence an d grade of dysplasia. In patients with high-grade dysplasia and/or early ad enocarcinoma, oesophagectomy is curative. Given the important clinical and economic implications of GORD complicated by Barrett's oesophagus, we review the costs associated with screening, sur veillance and treatment for this condition. Although the majority of physic ians recommend and/or perform surveillance for dysplasia in the setting of Barrett's oesophagus, differences in endoscopic technique, surveillance int ervals and cancer perception among practitioners influence total costs. In the US, it is estimated that a population-wide surveillance program could p otentially result in a total cost of $US289.9 million. The outpatient manag ement of Barrett's oesophagus is estimated to cost $US1241 per year with me dication use alone accounting for over half of the total costs. Cost-effect iveness analyses have been performed to evaluate the economic impact and be nefit of surveillance for dysplasia and/or cancer. Studies to date have uti lised several outcome measures such as life-years gained, quality-adjusted life-years and cases of cancer detected. Therefore, the incremental cost-ef fectiveness ratios reported have varied greatly and are particularly sensit ive to the prevalence of Barrett's oesophagus in patients with GORD and the incidence of adenocarcinoma. Further epidemiological and clinical studies are likely to further define the economic impact of Barrett's oesophagus as a complication of GORD.