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.