Cost effectiveness of detecting Barrett's cancer.

Abstract

Background-Screening Barrett's oesophagus is controversial owing to a large variation in the reported incidence ofneoplastic change and lack of evidence that screening improves tumour prognosis. Conclusions-The cost of screening for Barrett's cancer is high but may be justified on the basis of the high incidence of detecting early stage disease.

Diagnosis of oesophageal cancer by detection of minichromosome maintenance 5 protein in gastric aspirates

“…Although the brush biopsy capsule is inexpensive, the hidden costs including preparation of slides and expert cytopathological assessment are considerable. Moreover, despite the alarming increase in the incidence of AdCa of the oesophagus in North America and Europe, screening for neoplasia in Barrett's oesophagus is controversial partly due to the invasive nature and expense of introducing endoscopic biopsy surveillance programmes (Wright et al, 1996).…”

Unresolved Issues in Barrett’s Esophagus in the New Millennium

“…Several retrospective studies clearly suggest that patients with Barrett's esophagus in whom adenocarcinoma was detected in a surveillance program have their cancers detected at an earlier stage with resulting dramatically improved 5-year survival compared to similar patients not undergoing rou- [72][73][74][75]. Furthermore, nodal involvement is far less likely in surveyed patients compared to nonsurveyed patients [73,74]. Since esophageal cancer survival is stage-dependent, these studies suggest that survival may be enhanced by endoscopic suveillance.…”

Reply

“…Regular surveillance is expensive, and at least the cost-effectiveness of the approach has been questioned. 3 The fact that about 10-20 esophageal biopsies may be needed during a single procedure, concerns about procedure time, cost and safety, may hinder widespread implementation of such surveillance programs.Induction of regression of Barrett's esophagus, especially the endoscopic ablative measures, has generated a lot of interest. In younger age patients, it may be an attractive method both to reduce the risk of malignancy and the cost of surveillance, but this still needs more proof.…”

“…Regular surveillance is expensive, and at least the cost-effectiveness of the approach has been questioned. 3 The fact that about 10-20 esophageal biopsies may be needed during a single procedure, concerns about procedure time, cost and safety, may hinder widespread implementation of such surveillance programs.…”

“…In our article, we reported a case of squamous cell carcinoma and reviewed the literature regarding squamous cell carcinoma. As the incidence of adenocarcinoma in esophagus is increasing in adults, 3 we should have included these very important articles in the issue. There are many unanswered questions about Barrett's esophagus among children.…”