Endoscopic Screening Program for Control of Esophageal Adenocarcinoma in Varied Populations: A Comparative Cost-Effectiveness Analysis

Joel H. Rubenstein*, Amir Houshang Omidvari, Brianna N. Lauren, William D. Hazelton, Francesca Lim, Sarah Xinhui Tan, Chung Yin Kong, Minyi Lee, Ayman Ali, Chin Hur, John M. Inadomi, Georg Luebeck, Iris Lansdorp-Vogelaar

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
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Abstract

Background & Aims: Guidelines suggest endoscopic screening for esophageal adenocarcinoma (EAC) among individuals with symptoms of gastroesophageal reflux disease (GERD) and additional risk factors. We aimed to determine at what age to perform screening and whether sex and race should influence the decision. Methods: We conducted comparative cost-effectiveness analyses using 3 independent simulation models. For each combination of sex and race (White/Black, 100,000 individuals each), we considered 41 screening strategies, including one-time or repeated screening. The optimal strategy was that with the highest effectiveness and an incremental cost-effectiveness ratio <$100,000 per quality-adjusted life-year gained. Results: Among White men, 536 EAC deaths were projected without screening, and screening individuals with GERD twice at ages 45 and 60 years was optimal. Screening the entire White male population once at age 55 years was optimal in 26% of probabilistic sensitivity analysis runs. Black men had fewer EAC deaths without screening (n = 84), and screening those with GERD once at age 55 years was optimal. Although White women had slightly more EAC deaths (n = 103) than Black men, the optimal strategy was no screening, although screening those with GERD once at age 55 years was optimal in 29% of probabilistic sensitivity analysis runs. Black women had a very low burden of EAC deaths (n = 29), and no screening was optimal, as benefits were very small and some strategies caused net harm. Conclusions: The optimal strategy for screening differs by race and sex. White men with GERD symptoms can potentially be screened more intensely than is recommended currently. Screening women is not cost-effective and may cause net harm for Black women.

Original languageEnglish
Pages (from-to)163-173
Number of pages11
JournalGastroenterology
Volume163
Issue number1
Early online date28 Mar 2022
DOIs
Publication statusPublished - 1 Jul 2022

Bibliographical note

Funding Information:
Conflicts of interest These authors disclose the following: Joel H. Rubenstein has received research funding from Lucid Diagnostics. Chin Hur provides consulting for Value Analytics Labs. John M. Inadomi provides consulting for Cernostics. The remaining authors disclose no conflicts.

Publisher Copyright:
© 2022

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