Cost-Effectiveness of Regular Surveillance Versus Endoscopy at Need for Patients With Barrett's Esophagus: Economic Evaluation Alongside the Barrett's Oesophagus Surveillance Study (BOSS) Randomized Controlled Trial.

This study reports the costs and quality of life outcomes from the BOSS trial and models the outcomes and cost-effectiveness of surveillance beyond the follow-up period of the BOSS study.

本研究报告了BOSS试验的成本和生活质量结果，并模拟了BOSS研究随访期后监测的结果和成本效益。

This trial showed similar stages and rates of esophageal cancer in both arms, but the regular surveillance arm did identify more high-grade dysplasia after a median of 12.8 years follow-up.

该试验显示，两组的食管癌分期和发生率相似，但在中位随访12.8年后，定期监测组识别出更多高级别不典型增生。

Methods

We used a decision tree model based on results from BOSS to conduct a cost-effectiveness analysis of costs and quality-adjusted life years (QALYs).

我们使用基于BOSS结果的决策树模型，进行了成本和质量调整生命年（QALYs）的成本效益分析。

A Markov model was used to extrapolate costs and outcomes over a further 10 years after the trial had ended, representing a 22.8-year time horizon.

使用马尔可夫模型来推算试验结束后10年的成本和结果，代表了22.8年的研究时间范围。

The proportion with high-grade dysplasia and QALYs was derived from the randomized trial.

高分级异型增生的比例和QALYs是根据随机试验得出的。

Results

The total costs associated with 2-yearly surveillance was $5309 vs $3182 in the at-need arm.

2年一次的监测相关总成本为5309美元，而在需要时进行监测的组别为3182美元。

Total QALYs in the 2-yearly endoscopy arm were 8.647 compared with 8.629 in the at-need arm.

2年一次内镜检查组的总QALYs为8.647，而在需要时进行内镜检查的组别为8.629。

Compared with at-need endoscopy, 2-yearly surveillance costs $115,563/QALY gained.

与应急内镜检查相比，每两年进行一次监测的成本效益为每增加一个质量调整生命年（QALY）花费115,563美元。

In the sensitivity analyses around assumptions on the proportion of high-grade dysplasia that is undetected in the at-need endoscopy arm, surveillance had an incremental cost effectiveness ratio of $94,513/QALY for the best-case and $146,272/QALY for the worst-case scenario.

在对应急内镜检查中未检测到的高级别异型增生比例的假设进行敏感性分析时，监测在最佳情况下的增量成本效益比为每增加一个质量调整生命年（QALY）花费94,513美元，在最坏情况下的增量成本效益比为每增加一个质量调整生命年（QALY）花费146,272美元。

Conclusions

Barrett's esophagus surveillance every 2 to 3 years is unlikely to be a cost-effective strategy.

每2至3年对Barrett食管进行监测不太可能是一种成本效益策略。

Guidelines should take this into account when deciding surveillance intervals.

在决定监测间隔时，指南应考虑这一点。