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

Autor:	Rubenstein JH; Center for Clinical Management Research, Lieutenant Charles S. Kettles Veterans Affairs Medical Center, Ann Arbor, Michigan; Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan; Cancer Epidemiology and Prevention Program, Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan. Electronic address: jhr@umich.edu., Omidvari AH; Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands., Lauren BN; Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Hazelton WD; Computational Biology Program, Fred Hutchinson Cancer Research Center, Seattle, Washington., Lim F; Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Tan SX; Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Kong CY; Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York., Lee M; Gastrointestinal Unit, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts; The Graduate Program in Bioinformatics, Boston University, Boston, Massachusetts., Ali A; Tulane University School of Medicine, New Orleans, Louisiana., Hur C; Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Inadomi JM; Department of Internal Medicine, University of Utah, Salt Lake City, Utah., Luebeck G; Computational Biology Program, Fred Hutchinson Cancer Research Center, Seattle, Washington., Lansdorp-Vogelaar I; Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	Gastroenterology [Gastroenterology] 2022 Jul; Vol. 163 (1), pp. 163-173. Date of Electronic Publication: 2022 Mar 29.
DOI:	10.1053/j.gastro.2022.03.037
Abstrakt:	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. (Published by Elsevier Inc.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu