Cost Considerations in Implementing a Screening and Surveillance Strategy for Barrett's Oesophagus

Best Pract Res Clin Gastroenterol. 2015 Feb;29(1):51-63. doi: 10.1016/j.bpg.2014.12.002. Epub 2014 Dec 18.


There is increasing concern over the rising costs of healthcare leading to debate regarding the use of resources to implement preventive strategies. Oesophageal adenocarcinoma and its precursor, Barrett's oesophagus provides an excellent opportunity to highlight this issue since cancer is uncommon even among individuals with documented Barrett's oesophagus. This review provides a brief introduction to economic analysis in healthcare and summarizes published studies of the cost-effectiveness of strategies to reduce mortality from cancer. Current best estimates highlight the cost-effectiveness of endoscopic ablation among patients with Barrett's oesophagus and high-grade dysplasia and the low cost-effectiveness of ablation among patients without dysplasia. The cost-effectiveness of ablation among patients with Barrett's and low-grade dysplasia is poorly defined due to the ambiguity of diagnosing dysplasia, the unknown risk of cancer among patients with low-grade dysplasia, and the uncertain durability of ablation to maintain remission from metaplasia and dysplasia and prevent cancer.

Keywords: Barrett oesophagus; Endoscopy; Mass screening; Oesophageal neoplasms.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Adenocarcinoma / prevention & control*
  • Barrett Esophagus / diagnosis*
  • Barrett Esophagus / economics*
  • Cost-Benefit Analysis
  • Early Detection of Cancer / economics*
  • Early Detection of Cancer / methods
  • Esophageal Neoplasms / prevention & control*
  • Esophagoscopy / economics
  • Humans
  • Mass Screening / economics
  • Mass Screening / methods
  • Precancerous Conditions / diagnosis*
  • Precancerous Conditions / economics*

Supplementary concepts

  • Adenocarcinoma Of Esophagus