Cost-Effectiveness of Regular Surveillance Versus Endoscopy at Need for Patients With Barrett’s Esophagus: Economic Evaluation Alongside the Barrett’s Oesophagus Surveillance Study (BOSS) Randomized Controlled Trial

Background & aims: The Barrett's Oesophagus Surveillance Study (BOSS) was the first randomized study of surveillance. This study reports the costs and quality of life outcomes from the BOSS trial and models the outcomes and cost-effectiveness of surveillance beyond the follow-up period of the BOSS study. This trial showed similar stages and rates of esophageal cancer in both arms, but the regular surveillance arm did identify more high-grade dysplasia after a median of 12.8 years follow-up. Methods: We used a decision tree model based on results from BOSS to conduct a cost-effectiveness analysis of costs and quality-adjusted life years (QALYs). A Markov model was used to extrapolate costs and outcomes over a further 10 years after the trial had ended, representing a 22.8-year time horizon. The proportion with high-grade dysplasia and QALYs was derived from the randomized trial. Results: The total costs associated with 2-yearly surveillance was $5309 vs $3182 in the at-need arm. Total QALYs in the 2-yearly endoscopy arm were 8.647 compared with 8.629 in the at-need arm. Compared with at-need endoscopy, 2-yearly surveillance costs $115,563/QALY gained. In the sensitivity analyses around assumptions on the proportion of high-grade dysplasia that is undetected in the at-need endoscopy arm, surveillance had an incremental cost effectiveness ratio of $94,513/QALY for the best-case and $146,272/QALY for the worst-case scenario. Conclusion: Barrett's esophagus surveillance every 2 to 3 years is unlikely to be a cost-effective strategy. Guidelines should take this into account when deciding surveillance intervals.

Citation

Deidda, M., Old, O., Jankowski, J., Attwood, S., Stokes, C., Kendall, C., Rasdell, C., Zimmermann, A., Massa, S., Love, S., Sanders, S., Hapeshi, J., Foy, C., Briggs, A., Barr, H., Moayyedi, P., & BOSS Trial team (2025). Cost-Effectiveness of Regular Surveillance Versus Endoscopy at Need for Patients With Barrett's Esophagus: Economic Evaluation Alongside the Barrett's Oesophagus Surveillance Study (BOSS) Randomized Controlled Trial. Gastroenterology, S0016-5085(25)00760-7. Advance online publication. https://doi.org/10.1053/j.gastro.2025.04.026

DOI

10.1053/j.gastro.2025.04.026

URI

https://hdl.handle.net/20.500.14709/246

Usage rights

CC BY-NC-ND 4.0

License

https://creativecommons.org/licenses/by-nc-nd/4.0/