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Healthcare Cost of Over-Diagnosis of Low-Grade Dysplasia in Barrett’s Esophagus

An Erratum to this article was published on 22 March 2016

Abstract

Introduction

Published reports have demonstrated that many Barrett’s esophagus patients are over-diagnosed as low-grade dysplasia (BE-LGD). We performed an analysis of the surveillance and treatment costs associated with the over-diagnosis of BE-LGD.

Methods

As the principal cost variables, we used endoscopic and histologic procedures performed during the recommended surveillance intervals for patients with BE-LGD, the national average Medicare reimbursement for the Current Procedural Terminology codes of the procedures performed, and a spreadsheet-based tool we created to determine the overall healthcare cost associated with the over-diagnosis of BE-LGD in the US population.

Results

The average excess cost (range) for every patient in the US who is over-diagnosed with BE-LGD is estimated to be $5557 ($3115 to $8072). The principal contributors to the excess cost of over-diagnosis of BE-LGD in these patients are: endoscopy ($2626 to $4639), pathologist biopsy review ($275 to $2185), and esophagogastroduodenoscopy-guided endoscopic ablation ($214 to $1249).

Conclusions

The healthcare cost of over-diagnosis of BE-LGD is significant. To reduce the overall healthcare cost impact of over-diagnosis of BE-LGD, strict adherence to the recommendations of the American Gastroenterological Association, American College of Gastroenterology, and American Society for Gastrointestinal Endoscopy that pathology review of all BE biopsy specimens be performed by a gastrointestinal pathologist is warranted.

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Acknowledgments

No funding or sponsorship was received for this study or publication of this article. The authors would like to acknowledge Suzanne Ridner for her editorial assistance. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Disclosures

Richard Lash MD is an employee of Miraca Life Sciences, a subspecialty pathology services company which may benefit from data that demonstrates cost savings for patients who receive subspecialty care. Frank Wians PhD was compensated for time spent designing the Excel spreadsheet, the “Healthcare Cost Impact Calculator.” Thomas Deas MD has nothing to disclose.

Compliance with Ethics Guidelines

This article does not contain any new studies with human or animal subjects performed by any of the authors.

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Correspondence to Richard H. Lash.

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Lash, R.H., Deas, T.M. & Wians, F.H. Healthcare Cost of Over-Diagnosis of Low-Grade Dysplasia in Barrett’s Esophagus. Adv Ther 33, 684–697 (2016). https://doi.org/10.1007/s12325-016-0308-7

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Keywords

  • Barrett’s esophagus
  • Endoscopic surveillance
  • Health economic impact
  • Low-grade dysplasia
  • Over-diagnosis