Streitz J M, Ellis F H, Tilden R L, Erickson R V
Duluth Clinic, University of Minnesota School of Medicine, 55805, USA.
Am J Gastroenterol. 1998 Jun;93(6):911-5. doi: 10.1111/j.1572-0241.1998.00275.x.
Endoscopic surveillance of Barrett's esophagus is commonly practiced to detect malignancy in an early and curable stage. However, the cost-effectiveness of this practice has been questioned. To clarify this issue, we undertook a cost analysis of endoscopic surveillance to detect adenocarcinoma in Barrett's esophagus compared with mammography used to detect occult carcinoma of the breast, a widely accepted cancer surveillance technique.
The rate of esophageal adenocarcinoma detected by endoscopic surveillance was calculated for Duluth Clinic patients with Barrett's esophagus seen from 1980 to 1995 and compared with published rates. The rate of occult breast cancer detection was calculated for all women undergoing surveillance mammography at the Duluth Clinic for the year 1994 and compared with published rates. Costs for screening studies and therapy for cancer treatment for both cancers were calculated based on clinical results and assumptions regarding outcomes derived from published reports, and the costs were compared.
Endoscopic surveillance of 149 patients with benign Barrett's esophagus was performed for a total of 510 patient-yr, during which time seven patients developed adenocarcinoma, an incidence of one case per 73 patient-yr of follow-up. Occult breast cancer was detected in 50 of 12,537 mammograms, a detection rate of 0.4%. The incidences in both cases were comparable to published figures. The costs of detecting a case of adenocarcinoma in Barrett's esophagus and occult breast cancer were $37,928 and $54,513, respectively, and those for treatment resulting in cure were $83,340 and $83,292. Cost per life-yr saved was $4,151 for adenocarcinoma in Barrett's esophagus and $57,926 for breast cancer.
Endoscopic surveillance of patients with Barrett's esophagus compares favorably with the common practice of surveillance mammography to detect early breast cancer, and should therefore be considered to be as cost-effective as surveillance mammography.
内镜监测巴雷特食管常用于在早期可治愈阶段检测恶性肿瘤。然而，这种做法的成本效益受到了质疑。为了阐明这个问题，我们对内镜监测巴雷特食管以检测腺癌进行了成本分析，并与用于检测隐匿性乳腺癌的乳房X线摄影术进行了比较，乳房X线摄影术是一种广泛接受的癌症监测技术。
计算1980年至1995年在德卢斯诊所就诊的巴雷特食管患者通过内镜监测检测到食管腺癌的发生率，并与已发表的发生率进行比较。计算1994年在德卢斯诊所接受乳房X线摄影监测的所有女性中隐匿性乳腺癌的检测率，并与已发表的发生率进行比较。根据临床结果和从已发表报告中得出的关于结果的假设，计算两种癌症的筛查研究和癌症治疗费用，并对费用进行比较。
对149例良性巴雷特食管患者进行了内镜监测，共监测510患者年，在此期间有7例患者发生腺癌，随访73患者年的发病率为每例1例。在12537次乳房X线摄影中有50例检测到隐匿性乳腺癌，检测率为0.4%。两种情况的发生率均与已发表的数据相当。检测一例巴雷特食管腺癌和隐匿性乳腺癌的成本分别为37928美元和54513美元，治愈性治疗的成本分别为83340美元和83292美元。巴雷特食管腺癌每挽救一年生命的成本为4151美元，乳腺癌为57926美元。
巴雷特食管患者的内镜监测与检测早期乳腺癌的乳房X线摄影常规做法相比具有优势，因此应被视为与乳房X线摄影监测具有相同的成本效益。
