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. (...)
Mots-clés Pascal : Oesophage Barrett, Surveillance, Oesophagoscopie, Dépistage, Transformation maligne, Carcinome, Analyse avantage coût, Etude comparative, Homme, Appareil digestif pathologie, Oesophage pathologie, Economie santé, Endoscopie, Tumeur maligne
Mots-clés Pascal anglais : Barrett esophagus, Surveillance, Esophagoscopy, Medical screening, Malignant transformation, Carcinoma, Cost benefit analysis, Comparative study, Human, Digestive diseases, Esophageal disease, Health economy, Endoscopy, Malignant tumor
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0345331
Code Inist : 002B24E06. Création : 27/11/1998.