Premium
The cost‐effectiveness of biomarkers for predicting the development of oesophageal adenocarcinoma
Author(s) -
RUBENSTEIN J. H.,
VAKIL N.,
INADOMI J. M.
Publication year - 2005
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2005.02536.x
Subject(s) - biomarker , medicine , esophagectomy , adenocarcinoma , population , esophageal cancer , oncology , cancer , environmental health , biochemistry , chemistry
Summary Background: The recommended surveillance strategy for oesophageal adenocarcinoma may prevent as few as 50% of cancer deaths. Tissue biomarkers have been proposed to identify high‐risk patients. Aim: To determine performance characteristics of an ideal biomarker, or panel of biomarkers, that would make its use more cost‐effective than the current surveillance strategy. Methods: We created a Markov model using data from published literature, and performed a cost‐utility analysis. The population consisted of 50‐year‐old Caucasian men with gastro‐oesophageal reflux, who were monitored until age 80. We examined strategies of observation only, current practice (dysplasia‐guided surveillance), surveillance every 3 months for patients with a positive biomarker (biomarker‐guided surveillance), and oesophagectomy immediately for a positive biomarker (biomarker‐guided oesophagectomy). The primary outcome was the threshold cost and performance characteristics needed for a biomarker to be more cost‐effective than current practice. Results: Regardless of the cost, the biomarker needs to be at least 95% specific for biomarker‐guided oesophagectomy to be cost‐effective. For biomarker‐guided surveillance to be cost‐effective, a $100 biomarker could be 80% sensitive and specific. Conclusions: Biomarkers predicting the development of oesophageal adenocarcinoma would need to be fairly accurate and inexpensive to be cost‐effective. These results should guide the development of biomarkers for oesophageal adenocarcinoma.