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Asociación Mexicana de Gastroenterología

2006, Number 1

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Rev Gastroenterol Mex 2006; 71 (1)

Is the endoscopic surveillance recommended for patients with Barrett’s esophagus a cost-effective strategy?

Remes-Troche JM, Ramírez-Arias JF, Gómez-Escudero O, Valdovinos-Andraca F, Vargas-Vorácková F

Language: Spanish
References: 33
Page: 46-54
PDF size: 77.39 Kb.


ABSTRACT

Objective: Evaluate the cost-effectiveness of the American College of Gastroenterology (ACG) guidelines for the surveillance of Barrett’s esophagus (BE) in the context of a Mexican cohort of patients with BE and no dysplasia. Background: For patients with BE and no dysplasia, the ACG has recommended endoscopic surveillance every three years. The cost-benefit of this strategy has been evaluated in populations with an annual incidence of esophageal adenocarcinoma (EA) of 1%-5%. Methods: Demographic, clinical, surveillance and disease progression characteristics were analysed in patients with BE and no dysplasia seen at a terciary care center. Four surveillance strategies were considered, namely endoscopy every one, two, three and four years. Direct medical cost of endoscopy was $2,950.00 Mexican pesos ($256.52 USD). Total costs, cost-effectiveness ratios and marginal costs were determined assuming a cohort of 100 BE patients followed for a period of 10 years. Results: A cohort of 185 BE patients was incepted, with a male:female ratio of 1.28:1, mean age of 55.14 years and mean follow-up of 7.1 years. Annual progression rate from no dysplasia to high grade dysplasia and AE was 0.30%. The lowest cost-effectiveness ratio was observed with endoscopic surveillance every five years, with a cost of $202,913.86 Mexican pesos ($17,644.68 USD) per high grade dysplasia and AE diagnosed. Conclusions: In Mexican patients with BE and no dysplasia, progression to high grade dysplasia and AE is lower than reported. This makes the performance of endoscopy every five years a more cost-effective surveillance strategy in our environment.


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