Surveillance of Barrett's oesophagus: do we yet know whether it is worthwhile?

In 2004, the Peninsula Technology Assessment Group developed an economic model to assess the effectiveness and cost effectiveness of surveillance of Barrett's oesophagus in preventing morbidity and mortality from oesophageal adenocarcinoma. The conclusion then was that surveillance was dominated (ie, cost more and conferred less health benefit) by non-surveillance in most scenarios and that surveillance was unlikely to be cost effective at usual levels of willingness to pay. The model outputs were highly sensitive, however, to several parameters for which the data were very uncertain. While there are now better estimates of some of the model inputs, such as cancer risk and quality of life, the revised values make it less likely that surveillance could prove cost effective. There remains considerable uncertainty around other key inputs. At present, there seems little reason to change our original conclusion that surveillance of Barrett's oesophagus is unlikely to be cost effective and a definitive answer may only be possible from clinical trials now in progress. As newer endoscopic techniques for treating Barrett's oesophagus and adenocarcinoma become more widely used, however, conventional surveillance programmes may no longer be undertaken, and revised economic models will be needed to assess the cost effectiveness of the new clinical pathways.