Cost implications of endoscopic surveillance of patients with Barrett's oesophagus

Background: The cost implications of a 13‐year endoscopic surveillance programme for patients with Barrett's oesophagus were assessed and it was considered whether this represents a justifiable use of resources. Methods: From a population of 597 patients with Barrett's oesophagus, 357 patients (207 men; mean age 61 years) entered a yearly endoscopic surveillance programme. Twelve patients (11 men) developed adenocarcinoma a mean of 72 months after entering the programme. The costs of the surveillance programme were calculated using figures for this institution. Results: The cost of detecting one cancer at the institution's incidence rate of one cancer per 69 patient‐years of follow‐up was £24 236. The cost for male patients was £15 801 and for female patients £122 973. For male patients with specialized mucosa the cost was £13 969 per cancer detected. Comparing the stage presentation of surveillance cancers with the stage of adenocarcinomas presenting generally in this institution, the cost per life‐year saved was estimated at £6097 for male patients. Conclusion: Yearly endoscopic surveillance of patients with Barrett's oesophagus is expensive compared with other established screening programmes (e.g. £6006 per breast cancer detected) but for male patients with specialized mucosa it is probably justified. However, its role in female patients must be questioned given the high cost and low yield of cancers. © 1999 British Journal of Surgery Society Ltd