Barrett's oesophagus - A review of costs of the illness

Barrett's oesophagus is a premalignant complication that occurs in approximately 10% of patients with gastro-oesophageal reflux disease (GORD). In patients with Barrett's oesophagus, the risk of adenocarcinoma of the oesophagus approaches 0.5% per patient-years. Therefore, practice guidelines have been developed that suggest screening patients with GORD, particularly those with long-standing symptoms and those aged greater than or equal to 50 years 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 screening with the frequency of subsequent endoscopies dictated by the presence and grade of dysplasia. In patients with high-grade dysplasia and/or early adenocarcinoma, oesophagectomy is curative. Given the important clinical and economic implications of GORD complicated by Barrett's oesophagus, we review the costs associated with screening, surveillance and treatment for this condition. Although the majority of physicians recommend and/or perform surveillance for dysplasia in the setting of Barrett's oesophagus, differences in endoscopic technique, surveillance intervals and cancer perception among practitioners influence total costs. In the US, it is estimated that a population-wide surveillance program could potentially result in a total cost of $US289.9 million. The outpatient management of Barrett's oesophagus is estimated to cost $US1241 per year with medication use alone accounting for over half of the total costs. Cost-effectiveness analyses have been performed to evaluate the economic impact and benefit of surveillance for dysplasia and/or cancer. Studies to date have utilised several outcome measures such as life-years gained, quality-adjusted life-years and cases of cancer detected. Therefore, the incremental cost-effectiveness ratios reported have varied greatly and are particularly sensitive 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.