Authors: RUBENSTEIN, J. H.¹; VAKIL, N.²; INADOMI, J. M.

Source: Alimentary Pharmacology & Therapeutics, Volume 22, Number 2, July 2005 , pp. 135-146(12)

Publisher: Wiley-Blackwell

Abstract:

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.

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1365-2036.2005.02536.x

Affiliations: 1: University of Michigan Health System, Ann Arbor, MI, USA 2: University of Wisconsin Medical School, Milwaukee, WI, USA

Publication date: 2005-07-01

Related content

• In this: publication
• By this: publisher
• In this Subject: Pathology ,  Pharmacology ,  Surgery ,  Therapeutics & Alternative Medicine
• By this author: RUBENSTEIN, J. H. ;  VAKIL, N. ;  INADOMI, J. M.

Website © Publishing Technology. Article copyright remains with the publisher, society or author(s) as specified within the article.

• Terms and conditions
• Privacy policy
• Information for advertisers