Costs associated with Barrett's esophagus screening in the community: an economic analysis of a prospective randomized controlled trial of sedated versus hospital unsedated versus mobile community unsedated endoscopy.

Autor: Moriarty JP; Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA., Shah ND; Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA., Rubenstein JH; Veteran's Affairs Center for Clinical Management Research and Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA., Blevins CH; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Johnson M; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Katzka DA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Wang KK; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Wongkeesong LM; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Ahlquist DA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Iyer PG; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Jazyk: angličtina
Zdroj: Gastrointestinal endoscopy [Gastrointest Endosc] 2018 Jan; Vol. 87 (1), pp. 88-94.e2. Date of Electronic Publication: 2017 Apr 25.
DOI: 10.1016/j.gie.2017.04.019
Abstrakt: Background and Aims: Data on the economic impact associated with screening for Barrett's esophagus (BE) are limited. As part of a comparative effectiveness randomized trial of unsedated transnasal endoscopy (uTNE) and sedated EGD (sEGD), we assessed costs associated with BE screening.
Methods: Patients were randomly allocated to 3 techniques: sEGD or uTNE in a hospital setting (huTNE) versus uTNE in a mobile research van (muTNE). Patients were called 1 and 30 days after screening to assess loss of work (because of the screening procedure) and medical care sought after procedure. Direct medical costs were extracted from billing claims databases. Indirect costs (loss of work for subject and caregiver) were estimated using patient reported data. Statistical analyses including multivariable analysis accounting for comorbidities were conducted to compare costs.
Results: Two hundred nine patients were screened (61 sEGD, 72 huTNE, and 76 muTNE). Thirty-day direct medical costs and indirect costs were significantly higher in the sEGD than the huTNE and muTNE groups. Total costs (direct medical + indirect costs) were also significantly higher in the sEGD than in the uTNE group. The muTNE group had significantly lower costs than the huTNE group. Adjustment for age, sex, and comorbidities on multivariable analysis did not change this conclusion.
Conclusions: Short-term direct, indirect, and total costs of screening are significantly lower with uTNE compared with sEGD. Mobile uTNE costs were lower than huTNE costs, raising the possibility of mobile screening as a novel method of screening for BE and esophageal adenocarcinoma.
(Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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