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Am J Gastroenterol

Title:		Comparative Cost Effectiveness of Reflux-Based and Reflux-Independent Strategies for Barrett's Esophagus Screening
Author(s):		Sami SS; Moriarty JP; Rosedahl JK; Borah BJ; Katzka DA; Wang KK; Kisiel JB; Ragunath K; Rubenstein JH; Iyer PG;
Address:		"Division of Surgery and Interventional Science, University College London, London, UK. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA. Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA. Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. Curtin University, Perth, Australia. Veterans Affairs Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA. Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA"
Journal Title:		Am J Gastroenterol
Year:		2021
Volume:		116
Issue:		8
Page Number:		1620 - 1631
DOI:		10.14309/ajg.0000000000001336
ISSN/ISBN:		1572-0241 (Electronic) 0002-9270 (Print) 0002-9270 (Linking)
Abstract:		"INTRODUCTION: Minimally invasive tests for Barrett's esophagus (BE) detection have raised the prospect of broader nonreflux-based testing. Cost-effectiveness studies have largely studied men aged 50 years with chronic gastroesophageal reflux disease (GERD) symptoms. We evaluated the comparative cost effectiveness of BE screening tests in GERD-based and GERD-independent testing scenarios. METHODS: Markov modeling was performed in 3 scenarios in 50 years old individuals: (i) White men with chronic GERD (GERD-based); (ii) GERD-independent (all races, men and women), BE prevalence 1.6%; and (iii) GERD-independent, BE prevalence 5%. The simulation compared multiple screening strategies with no screening: sedated endoscopy (sEGD), transnasal endoscopy, swallowable esophageal cell collection devices with biomarkers, and exhaled volatile organic compounds. A hypothetical cohort of 500,000 individuals followed for 40 years using a willingness to pay threshold of $100,000 per quality-adjusted life year (QALY) was simulated. Incremental cost-effectiveness ratios (ICERs) comparing each strategy with no screening and comparing screening strategies with each other were calculated. RESULTS: In both GERD-independent scenarios, most non-sEGD BE screening tests were cost effective. Swallowable esophageal cell collection devices with biomarkers were cost effective (<$35,000/QALY) and were the optimal screening tests in all scenarios. Exhaled volatile organic compounds had the highest ICERs in all scenarios. ICERs were low (<$25,000/QALY) for all tests in the GERD-based scenario, and all non-sEGD tests dominated no screening. ICERs were sensitive to BE prevalence and test costs. DISCUSSION: Minimally invasive nonendoscopic tests may make GERD-independent BE screening cost effective. Participation rates for these strategies need to be studied"
Keywords:		"Aged Anesthesia/economics Barrett Esophagus/*diagnosis/*therapy Biomarkers/analysis Breath Tests *Cost-Benefit Analysis Endoscopy, Gastrointestinal/economics Female Gastroesophageal Reflux/*diagnosis/*therapy Humans Male Markov Chains Mass Screening/*econ;"
Notes:		"MedlineSami, Sarmed S Moriarty, James P Rosedahl, Jordan K Borah, Bijan J Katzka, David A Wang, Kenneth K Kisiel, John B Ragunath, Krish Rubenstein, Joel H Iyer, Prasad G eng I01 CX000899/CX/CSRD VA/ R01 CA241164/CA/NCI NIH HHS/ U01 CA199336/CA/NCI NIH HHS/ Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S. 2021/06/17 Am J Gastroenterol. 2021 Aug 1; 116(8):1620-1631. doi: 10.14309/ajg.0000000000001336"