European journal of cancer (Oxford, England : 1990) · 2008
Surveillance of Barrett's oesophagus: is it worthwhile?
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Somerville M, Garside R, Pitt M, Stein K
Аннотация
OBJECTIVE: To assess the cost-effectiveness of surveillance of Barrett's oesophagus.
DESIGN: Cost-utility model.
SETTING: UK NHS.
PATIENTS: One thousand 55-year-old men with Barrett's oesophagus.
INTERVENTION: Surveillance programme: endoscopy and biopsy at 3 yearly intervals for non-dysplastic Barrett's oesophagus; low-grade dysplasia yearly; high grade-dysplasia 3 monthly.
OUTCOME MEASURES: Incremental cost-effectiveness ratio, expected value of perfect information.
RESULTS: Non-surveillance dominated surveillance (i.e. cost less and conferred more benefit), but there was substantial uncertainty around many of the model inputs. Probabilistic analyses showed that non-surveillance cost less and conferred more benefit in 75% of model runs. Surveillance was cost-effective at usual levels of willingness to pay in 11% of runs. For people with Barrett's oesophagus in England and Wales, a value of pound6.5 million is placed on acquiring perfect information about surveillance of Barrett's oesophagus.
CONCLUSIONS: The PenTAG cost-utility model suggests that surveillance programmes do more harm than good.
DESIGN: Cost-utility model.
SETTING: UK NHS.
PATIENTS: One thousand 55-year-old men with Barrett's oesophagus.
INTERVENTION: Surveillance programme: endoscopy and biopsy at 3 yearly intervals for non-dysplastic Barrett's oesophagus; low-grade dysplasia yearly; high grade-dysplasia 3 monthly.
OUTCOME MEASURES: Incremental cost-effectiveness ratio, expected value of perfect information.
RESULTS: Non-surveillance dominated surveillance (i.e. cost less and conferred more benefit), but there was substantial uncertainty around many of the model inputs. Probabilistic analyses showed that non-surveillance cost less and conferred more benefit in 75% of model runs. Surveillance was cost-effective at usual levels of willingness to pay in 11% of runs. For people with Barrett's oesophagus in England and Wales, a value of pound6.5 million is placed on acquiring perfect information about surveillance of Barrett's oesophagus.
CONCLUSIONS: The PenTAG cost-utility model suggests that surveillance programmes do more harm than good.