Screening for and surveillance of Barrett’s esophagus: a cost-effectiveness assessment

Esophageal adenocarcinoma (EAC) is the most common type of esophageal cancer in Western countries. Various risk factors are associated with EAC, of which Barrett’s esophagus (BE) is the most important one. Targeted screening of well-defined high-risk populations and surveillance of BE patients using an upper gastrointestinal (GI) endoscopy is recommended by several clinical practice guidelines in the world. However, there are discrepancies in guidelines’ recommendations.
In this thesis, we conducted cost-effectiveness analyses on BE screening and surveillance strategies. First, we focused on screening for BE and evaluated the cost-effectiveness of using minimally invasive method to screen high-risk people for BE, and we assessed the impact of including unrelated health effects and costs on our cost-effectiveness estimates. Then, we evaluated several ways to further improve the cost-effectiveness of BE surveillance by optimizing different aspects of BE management. Subsequently, we evaluated how the lack of adherence to surveillance guidelines for BE patients can impact cost-effectiveness estimates