Costs associated with Barrett’s esophagus screening in the community: an economic analysis of a prospective randomized controlled trial of sedated versus hospital unsedated versus mobile community unsedated endoscopy

• Published in: Gastrointestinal endoscopy Vol. 87; no. 1; pp. 88 - 94.e2
• Main Authors: Moriarty, James P., Shah, Nilay D., Rubenstein, Joel H., Blevins, Christopher H., Johnson, Michele, Katzka, David A., Wang, Kenneth K., Wongkeesong, Louis Michel, Ahlquist, David A., Iyer, Prasad G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2018
• Subjects: Adenocarcinoma - diagnosis; Aged; Barrett Esophagus - diagnosis; Conscious Sedation - economics; Costs and Cost Analysis; Early Detection of Cancer - economics; Early Detection of Cancer - methods; Economics, Hospital; Endoscopy, Digestive System - economics; Endoscopy, Digestive System - methods; Esophageal Neoplasms - diagnosis; Female; Gastroenterology and Hepatology; Health Care Costs; Hospitals; Humans; Linear Models; Male; Mass Screening - economics; Middle Aged; Minnesota; Mobile Health Units - economics; Multivariate Analysis; uTNE; BE; muTNE; EAC; REPCDW; sEGD; CPT-4; huTNE; sedated EGD; Current Procedural Terminology, 4th Edition; unsedated transnasal endoscopy in a mobile research van; Rochester Epidemiology Project Cost Data Warehouse; Barrett’s esophagus; esophageal adenocarcinoma; unsedated transnasal endoscopy in a hospital setting; unsedated transnasal endoscopy
• ISSN: 0016-5107; 1097-6779; 1097-6779
• DOI: 10.1016/j.gie.2017.04.019

Data on the economic impact associated with screening for Barrett’s esophagus (BE) are limited. As part of a comparative effectiveness randomized trial of unsedated transnasal endoscopy (uTNE) and sedated EGD (sEGD), we assessed costs associated with BE screening. Patients were randomly allocated to 3 techniques: sEGD or uTNE in a hospital setting (huTNE) versus uTNE in a mobile research van (muTNE). Patients were called 1 and 30 days after screening to assess loss of work (because of the screening procedure) and medical care sought after procedure. Direct medical costs were extracted from billing claims databases. Indirect costs (loss of work for subject and caregiver) were estimated using patient reported data. Statistical analyses including multivariable analysis accounting for comorbidities were conducted to compare costs. Two hundred nine patients were screened (61 sEGD, 72 huTNE, and 76 muTNE). Thirty-day direct medical costs and indirect costs were significantly higher in the sEGD than the huTNE and muTNE groups. Total costs (direct medical + indirect costs) were also significantly higher in the sEGD than in the uTNE group. The muTNE group had significantly lower costs than the huTNE group. Adjustment for age, sex, and comorbidities on multivariable analysis did not change this conclusion. Short-term direct, indirect, and total costs of screening are significantly lower with uTNE compared with sEGD. Mobile uTNE costs were lower than huTNE costs, raising the possibility of mobile screening as a novel method of screening for BE and esophageal adenocarcinoma.