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Endosheath ultrathin transnasal endoscopy is a cost-effective method for screening for Barrett’s esophagus in patients with GERD symptoms
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2018-10-29 , DOI: 10.1016/j.gie.2018.10.024
Judith Honing , Wietske Kievit , Jan Bookelaar , Yonne Peters , Prasad G. Iyer , Peter D. Siersema

Background and Aims

Barrett’s esophagus (BE) screening is currently not considered to be cost effective in the general population but may be effective in high-risk subgroups, such as 50-year-old white men with chronic reflux disease (GERD). A new modality for screening is unsedated transnasal endoscopy using endosheath technology (uTNE), which has been shown to be safe and effective in clinical practice. In this study, we determined the cost-utility of uTNE in a high-risk subgroup compared with no screening or screening with standard endoscopy.

Methods

A Markov model was used to simulate screening of 50-year-old white men with symptoms of GERD with either uTNE or standard endoscopy compared with no screening, over a lifetime horizon. Input variables were based on the literature and recent data on uTNE screening for BE. The study was designed from a healthcare payer perspective by using direct costs. Primary outcome measures were costs, quality-adjusted life years (QALYs), and the incremental cost-utility ratio (ICUR) of uTNE and standard endoscopy compared with no screening. Sensitivity analysis was performed for several factors, such as prevalence of BE.

Results

Costs of uTNE, standard endoscopy, and no screening were estimated at, $2495, $2957, and $1436, respectively. Compared with no screening, uTNE screening resulted in an overall QALY increase of 0.039 (95% percentile 0.018; 0.063) and an ICUR of $29,446 per QALY gained (95% confidence interval [CI], 18.516-53.091), whereas standard endoscopy compared with no screening resulted in a QALY increase of 0.034 (95% CI, 0.015-0.056) and an ICUR of $47,563 (95% CI, 31,036-82,970).

Conclusion

Both uTNE and standard endoscopy seem to be cost-effective screening methods in a screening cohort of 50-year-old white men with GERD at a willingness-to-pay cutoff of $50,000.



中文翻译:

胃内超薄经鼻内窥镜检查是筛查患有GERD症状的患者的Barrett食道的一种经济有效的方法

背景和目标

巴雷特食管(BE)筛查目前不被认为在一般人群中具有成本效益,但在高风险亚组(例如患有慢性反流病(GERD)的50岁白人)中可能有效。一种新的筛查手段是使用内鞘技术(uTNE)的非镇静性经鼻内窥镜检查,该方法已被证明在临床实践中是安全有效的。在这项研究中,我们确定了不进行筛查或使用标准内窥镜筛查的高风险亚组中uTNE的成本-效用。

方法

马尔可夫模型用于模拟对50岁的GERD症状的50岁白人进行uTNE或标准内窥镜检查,而不进行筛查。输入变量基于文献和关于BE的uTNE筛选的最新数据。该研究是从医疗保健付款人的角度通过使用直接成本而设计的。主要结局指标包括成本,质量调整生命年(QALYs)以及uTNE和标准内窥镜检查与未筛查相比的增量成本-效用比(ICUR)。针对几个因素(例如BE的患病率)进行了敏感性分析。

结果

uTNE,标准内窥镜检查和不进行筛查的费用分别估计为2495美元,2957美元和1436美元。与不进行筛查相比,uTNE筛查的总体QALY增加了0.039(95%百分位数0.018; 0.063),ICUR为每获得的QALY 29446美元(95%置信区间[CI],18.516-53.091),而标准内窥镜检查与没有筛选会导致QALY增加0.034(95%CI,0.015-0.056)和ICUR为$ 47,563(95%CI,31,036-82,970)。

结论

在50名GERD白人男性的筛查队列中,uTNE和标准内窥镜检查似乎都是具有成本效益的筛查方法,其支付意愿为$ 50,000。

更新日期:2018-10-29
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