Sa1071 Direct and Indirect Costs Associated With Barrett's Esophagus Screening: Results From a Community Randomized Controlled Trial

Abstract

Background and Aims: Real costs associated with screening for Barrett's esophagus (BE) are not known. Modeling studies concluding that screening for BE is cost effective have used estimates based on several assumptions. As part of a prospective randomized controlled trial assessing the comparative effectiveness of unsedated transnasal endoscopy (uTNE) and sedated endoscopy (sEGD), real direct and indirect costs associated with BE screening were prospectively collected and compared. Methods: Patients were randomly allocated to three screening techniques: sEGD or uTNE in a hospital setting (huTNE) versus uTNE in a mobile research van (muTNE). Following the procedure, patients were called at 1 and 30 days by a research coordinator to assess adverse effects, loss of work (for the screening procedure) and medical care sought after the BE screening procedure. Direct medical (initial screening test and medical costs within 30 days of test), indirect (loss of work for subject and caregiver) and total medical costs were extracted using the Olmsted County Healthcare Expenditure and Utilization Database (OCHEUD). This claims-based database contains details on healthcare utilization, associated charges, and inflation adjusted economic costs for patients in Olmsted County. Costs were analyzed descriptively and compared using multivariate regression. Covariates in the model included age, sex and comorbidities (measured using the Hwang method). To test whether the assumed cost affects results, sensitivity analyses were performed by varying costs from 50% to 300%. Results: 209 patients (46% males, mean age 65 years) were screened (61 with sEGD, 72 with huTNE and 76 with muTNE), out of 459 who were invited (participation rate 46%). Clinical effectiveness of uTNE screening was comparable to that of sEGD (Sami, AmJGastro 2014). 4 sEGD and 4 muTNE patients did not have follow-up interviews and were excluded from analyses. 30 day direct medical costs and indirect costs were higher in the sEGD than in huTNE and muTNE groups. Total costs (direct medical + indirect costs) were significantly higher in the sEGD group than in the uTNE groups (Table 1). muTNE had significantly lower costs than the huTNE group on univariate and multivariate analysis. (Table 2). Sensitivity analyses still resulted in significantly higher costs for sEGD compared to muTNE for both low and high values (results not shown). Conclusions: In our prospective randomized comparative effectiveness trial, we demonstrate for the first time that real short term direct medical, indirect and total costs of BE screening are significantly lower with uTNE compared with sEGD. Costs associated with mobile uTNE were lower than with huTNE, raising the possibility of mobile screening (which has comparable clinical effectiveness to sEGD and huTNE) as a novel method of screening for BE and esophageal adenocarcinoma. Table 1. Total costs (30 day direct medical + indirect costs) over the one-month period following screening, by study group. (Costs in US$)