Cost effectiveness of detecting Barrett's cancer

Background-Screening Barrett's oesophagus is controversial owing to a large variation in the reported incidence of neoplastic change and lack of evidence that screening improves tumour prognosis. Aims-To determine the incidence of Barrett's cancer, its cost of detection, and stage of disease at time of diagnosis. Patients and Methods-Data from our surveillance programme have been reviewed to assess the incidence of malignant change, tumour stage at diagnosis, and the cost per cancer detected. Results-166 patients had annual endoscopic surveillance. Six patients (five men) developed cancer - an incidence of one cancer per 59 male and 167 female patient-years of follow up. The screened group had a significantly earlier stage than a control group of unscreened cancers (p<0.05). The cost of detecting one cancer was pound 14 868 for men and pound 42 084 for women. Conlusions-The cost of screening for Barrett's cancer is high but may be justified on the basis of the high incidence of detecting early stage disease.