Esophagus

29 - Comparative Cost-Effectiveness of Gastroesophageal Reflux Disease Centric and Population Based Barrett’s Esophagus Screening

Tuesday, October 9
8:40 AM - 8:50 AM
Location: Terrace Ballroom 2-3 (level 400)

Category: Esophagus
Sarmed S. Sami, MBChB, PhD, James Moriarty, MS, Jordan Rosedahl, BS, Bijan Borah, PhD, John Kisiel, MD, David A. Katzka, MD, Kenneth K. Wang, MD, David A. Ahlquist, MD, Prasad G. Iyer, MD
Mayo Clinic, Rochester, MN

Award: Fellows-in-Training Award (Esophagus Category)

Introduction: Current Barrett’s esophagus (BE) screening recommendations are gastroesophageal reflux disease (GERD) centric, but 40-50% of patients with BE or esophageal adenocarcinoma deny GERD. With the development of minimally invasive tests for BE screening, the prospect of population screening (all adults age ≥50) instead of targeted screening (white, male, age ≥50, GERD) has arisen. We aimed to evaluate the comparative cost effectiveness of current tests utilizing recently published data on prevalence, accuracy, screening uptake, and costs.   

Methods: Decision analytic methods were used to compare six screening strategies to no screening: sEGD, Cytosponge with TFF3 biomarker, Sponge on String (SoS) with methylated DNA markers, breath testing (E-Nose), hospital-based transnasal endoscopy (hTNE), and mobile unit-based transnasal endoscopy (mTNE). The Markov model simulated a hypothetical cohort of 100,000 individuals aged ≥50 followed up for 40 years. Patients could follow seven distinct health states: no BE, non-dysplastic BE, low grade dysplasia, high grade dysplasia, intramucosal cancer, symptomatic cancer, and death. sEGD was used as a confirmatory test of positive findings for all other diagnostic tests. Mean costs (direct as well as indirect costs resulting from missed or false positive diagnoses and cost of test uptake) were calculated for each strategy. Effectiveness of each option was assessed using quality adjusted life years (QALYs) from the extant literature.

Results: Screening (GERD centric : prevalence 8%, and population prevalence 1.6%) was associated with gains in QALYs compared to no screening (Table 1). Under the general population analysis, mean costs ranged from $120 (mTNE) to $554 (E-Nose). While mTNE was the dominant strategy, both the Cytosponge and SoS tests had the lowest incremental cost effectiveness ratios (ICERs) (Table 1). Under the GERD centric screening analysis, mean costs ranged from $212 (mTNE) to $768 (E-Nose). Cytosponge, SoS, hTNE, and mTNE were all dominant strategies compared to no screening. Of those, mTNE was the least costly and most effective strategy. The E-Nose had the highest ICER primarily due to lower accuracy estimates.

Discussion: While mTNE was the dominant strategy for both screening scenarios, this technique is not widely utilized and has been only evaluated in one center. Both Cytosponge and SoS strategies had very favorable ICERs in both strategies and may make population-based BE screening regardless of GERD status feasible.

Table 1: Main Results of the simulation models

Disclosures:
Sarmed Sami indicated no relevant financial relationships.
James Moriarty indicated no relevant financial relationships.
Jordan Rosedahl indicated no relevant financial relationships.
Bijan Borah indicated no relevant financial relationships.
John Kisiel: Exact Science – • Co-inventors licensed technology;Research Collaborators.
David Katzka: Shire Pharmaceuticals – Consultant.
Kenneth Wang: Boston Scientific – Consultant. Fuji – Grant/Research Support. Olympus – Consultant, Grant/Research Support.
David Ahlquist: Exact Sciences – Scientific Advisor; Co-inventors licensed technology; Research Collaborators.
Prasad Iyer: C2 Therapeutics – Grant/Research Support. Exact Sciences – Grant/Research Support.

Sarmed S. Sami

Advanced Esophageal Fellow
Mayo Clinic
Rochester, Minnesota

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