Objective: Endoscopic surveillance for non-dysplastic Barrett’s oesophagus is contentious and its cost-effectiveness is unclear. This study performed a cost-effectiveness analysis of surveillance with and without a hypothetical biomarker test, compared to no surveillance, using updated evidence. The biomarker test option involved 6-monthly surveillance for patients with a positive test .
Design: A simulation Markov model was constructed to synthesize evidence from large epidemiological studies. Costs and outcomes for surveillance were based on a coordinator-managed surveillance program in existence in South Australia involving 2040 patient years of follow-up. Extensive sensitivity analyses were performed to test plausible variation in crucial estimates (e.g., progression to malignancy) on the base results.
Results: Compared with no surveillance, 2-yearly endoscopic surveillance of patients with non-dysplastic Barrett’s oesophagus and 6-monthly surveillance of patients with low-grade dysplasia produced incremental cost per quality-adjusted life year (QALY) ratios of $61,260 for surveillance alone and $44,109 for surveillance modified by biomarker testing. Considering the uncertainty of the model parameters, the likelihood that surveillance alone was cost-effective compared with no surveillance was 30.3%, and surveillance with biomarker testing was 33.6%, at an acceptability threshold of AU$50,000 per QALY
Conclusion: Using best available estimates of the malignant potential of Barrett’s oesophagus, endoscopic surveillance of patients with non-dysplastic Barrett’s oesophagus is unlikely to be cost-effective for the majority of patients and depends heavily on the progression rates between dysplasia grades. However, further strategies to identify high-risk individuals might improve the economic acceptability of surveillance of non-dysplastic Barrett’s oesophagus.