Sex, comorbidity important considerations for discontinuing NDBE surveillance

A patient’s sex and comorbidity status are important factors to consider in determining the age at which to discontinue surveillance of nondysplastic Barrett’s oesophagus (NDBE), a recent study has found.

Researchers conducted a comparative modelling analysis using three independently design models to simulate NDBE patients (varying in sex, age, and comorbidity status) who had received regular surveillance until the present. Incremental costs and quality-adjusted life-years (QALYs) associated with one additional endoscopic surveillance were calculated and compared against not undergoing another surveillance session.

In men with NDBE, one additional endoscopic surveillance at 68 years of age could prevent 10 more cases of oesophageal adenocarcinoma (EAC) in 1,000 patients vs not performing surveillance. In this scenario, an incremental cost of USD 1 million would translate to 56 more QALYs, yielding an incremental cost-effectiveness ratio (ICER) of USD 23,600 per QALY, much lower than the set willingness-to-pay (WTP) threshold of USD 100,000 per QALY.

Increasing age in men diminished the net benefits of additional endoscopic surveillance, in turn increasing ICERs. At age 74 years, additional surveillance ceased being cost-effective for men with severe comorbidities. By 86 years of age, one more surveillance was not cost-effective for any level of comorbidity.

A similar trend was reported in women. ICER was below the WTP threshold at 68 years and increased with age and with higher levels of comorbidity. Relative to men, additional surveillance posed smaller benefits to women such that by age >75 years, one more session was no longer cost-effective for any level of comorbidity.