Cost effectiveness of detecting Barrett's cancer.

Abstract

Screening Barrett's oesophagus is controversial owing to a large variation in the reported incidence of neoplastic change and lack of evidence that screening improves tumour prognosis. To determine the incidence of Barrett's cancer, its cost of detection, and stage of disease at time of diagnosis. Data from our surveillance programme have been reviewed to assess the incidence of malignant change, tumour stage at diagnosis, and the cost per cancer detected. 166 patients had annual endoscopic surveillance. Six patients (five men) developed cancer-an incidence of one cancer per 59 male and 167 female patient-years of follow up. The screened group had a significantly earlier stage than a control group of unscreened cancers (p < 0.05). The cost of detecting one cancer was Pounds 14 868 for men and Pounds 42 084 for women. 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.