Inadomi John M, Sampliner Richard, Lagergren Jesper, Lieberman David, Fendrick A Mark, Vakil Nimish
Veterans Affairs Ann Arbor Health Systems, 2215 Fuller Road, Ann Arbor, MI 48105, USA.
Ann Intern Med. 2003 Feb 4;138(3):176-86. doi: 10.7326/0003-4819-138-3-200302040-00009.
Once-in-a-lifetime screening for Barrett esophagus has been proposed for patients with gastroesophageal reflux disease (GERD), but there is little evidence of its cost-effectiveness.
A decision analytic model was developed to examine no screening or surveillance and screening and surveillance for Barrett esophagus with dysplasia only or Barrett esophagus without dysplasia every 2 to 5 years. Low- or high-grade dysplasia received surveillance every 6 or 3 months, respectively.
Published literature and the Health Care Financing Administration.
50-year-old white men with symptoms of GERD.
50 years of age until 80 years of age or death.
Third-party payer.
Incremental cost-effectiveness ratio.
RESULTS OF BASE-CASE ANALYSIS: Screening with surveillance limited to patients with Barrett esophagus with dysplasia required $10 440 per quality-adjusted life-year (QALY) saved compared to no screening or surveillance. The incremental cost-effectiveness ratio of surveillance every 5 years in patients with Barrett esophagus without dysplasia compared to surveillance of patients with Barrett esophagus with dysplasia was $596 000 per QALY saved.
The annual incidence of adenocarcinoma must exceed 1 case per 54 patient-years of follow-up (1.9%) for surveillance of Barrett esophagus without dysplasia every 5 years to yield an incremental cost-effectiveness ratio less than $50 000 per QALY saved.
Screening 50-year-old men with symptoms of GERD to detect adenocarcinoma associated with Barrett esophagus is probably cost-effective. However, subsequent surveillance of patients with Barrett esophagus but no dysplasia, even at 5-year intervals, is an expensive practice.
有人提议对胃食管反流病（GERD）患者进行一次性巴雷特食管筛查，但几乎没有证据表明其成本效益如何。
1）确定对巴雷特食管高危人群进行筛查并对巴雷特食管伴发育异常患者或所有巴雷特食管患者进行监测的成本效益，以及2）将结果与不进行筛查或监测的成本效益进行比较。
开发了一个决策分析模型，以研究不进行筛查或监测以及每2至5年对仅伴有发育异常的巴雷特食管或不伴有发育异常的巴雷特食管进行筛查和监测的情况。低级别或高级别发育异常分别每6个月或3个月接受一次监测。
已发表的文献和医疗保健财务管理局。
有GERD症状的50岁白人男性。
50岁至80岁或直至死亡。
第三方支付者。
增量成本效益比。
与不进行筛查或监测相比，仅对伴有发育异常的巴雷特食管患者进行监测的筛查每挽救一个质量调整生命年（QALY）需要10440美元。与对伴有发育异常的巴雷特食管患者进行监测相比，对不伴有发育异常 的巴雷特食管患者每5年进行一次监测的增量成本效益比为每挽救一个QALY596000美元。
对于每5年对不伴有发育异常的巴雷特食管进行一次监测，腺癌的年发病率必须超过每54患者年随访1例（1.9%），才能使增量成本效益比低于每挽救一个QALY50000美元。
对有GERD症状的50岁男性进行筛查以检测与巴雷特食管相关的腺癌可能具有成本效益。然而，对巴雷特食管但无发育异常的患者进行后续监测，即使是每5年进行一次，也是一项昂贵的做法。
