Age to discontinue surveillance in BE should be based on comorbidity status, sex
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Clinicians should factor comorbidity status and sex when considering the optimal age to discontinue surveillance in patients with non-dysplastic Barrett’s esophagus.
“[Our comparative] modeling approach shows that in addition to chronological age, sex and the comorbidity status of [non-dysplastic Barrett’s Esophagus (NDBE)] patients are important factors to inform the decision when to discontinue surveillance,” Amir-Houshang Omidvari, MD, PhD, and colleagues wrote. “Our analysis finds that the optimal age for last surveillance of NDBE patients without comorbidity for women is 75 years and for men is 81 years. However, it may be up to 6 years earlier for women and up to 8 years earlier for men if patients have severe comorbidities.”
Omidvari, from the department of public health at Erasmus MC University Medical Center Rotterdam, the Netherlands, and colleagues used three developed models to stimulate patients diagnosed with non-dysplastic Barrett’s esophagus. Patients varied in age, sex and comorbidity level. Patients underwent regular surveillance until current age.
Incremental costs and quality-adjusted life-years gained from one additional endoscopic surveillance at the current age vs. not performing surveillance at that age were calculated.
“We determined the optimal age to end surveillance as the age at which incremental cost-effectiveness ratio (ICER) of one more surveillance was just below the willingness-to-pay threshold of $100,000/QALY,” Omidvari and colleagues wrote.
“The benefit of having one more surveillance endoscopy strongly depended on age, sex and comorbidity,” the researchers wrote.
“For men with NDBE and severe comorbidity, one additional surveillance at age 80 years provided 4 more QALYs per 1,000 BE patients at an additional cost of $1.2 million, while for women with severe comorbidity the benefit at that age was 7 QALYs at a cost of $1.3 million,” Omidvari and colleagues added.
According to researchers, the optimal ages for last surveillance in men with no, mild, moderate and severe comorbidity were 81, 80, 77 and 73 years, respectively. In women, the optimal ages were lower: 75, 73, 73 and 69 years, respectively.
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