Cost effectiveness of detecting Barrett's cancer

• Published in: Gut Vol. 39; no. 4; pp. 574 - 579
• Main Authors: Wright, T A, Gray, M R, Morris, A I, Gilmore, I T, Ellis, A, Smart, H L, Myskow, M, Nash, J, Donnelly, R J, Kingsnorth, A N
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01-10-1996; BMJ; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Aged, 80 and over; Barrett Esophagus - pathology; Barrett Esophagus - prevention & control; Biological and medical sciences; Cost-Benefit Analysis; Esophageal Neoplasms - prevention & control; Esophagoscopy; Esophagus; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Incidence; Male; Mass Screening - economics; Medical sciences; Middle Aged; Neoplasm Staging; Precancerous Conditions - prevention & control; Tumors; Human; Health economy; Malignant transformation; Esophageal disease; Risk factor; Digestive diseases; Barrett esophagus; Cost benefit analysis; Medical screening; Public health; Incidence
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.39.4.574

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 Pounds 14 868 for men and Pounds 42 084 for women. CONCLUSIONS: 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.