Surveillance of Barrett's oesophagus: Is it worthwhile?

Objective: To assess the cost-effectiveness of surveillance of Barrett's oesophagus. Design: Cost-utility model. Setting: UK NHS. Patients: One thousand 55-year-old men with Barrett's oesophagus. Intervention: Surveillance programme: endoscopy and biopsy at 3 yearly intervals for non-dysplastic Barrett's oesophagus; low-grade dysplasia yearly; high grade-dysplasia 3 monthly. Outcome measures: Incremental cost-effectiveness ratio, expected value of perfect information. Results: Non-surveillance dominated surveillance (i.e. cost less and conferred more benefit), but there was substantial uncertainty around many of the model inputs. Probabilistic analyses showed that non-surveillance cost less and conferred more benefit in 75% of model runs. Surveillance was cost-effective at usual levels of willingness to pay in 11% of runs. For people with Barrett's oesophagus in England and Wales, a value of 6.5 pound million is placed on acquiring perfect information about surveillance of Barrett's oesophagus. Conclusions: The PenTAG cost-utility model suggests that surveillance programmes do more harm than good. (c) 2008 Elsevier Ltd. All rights reserved.