The Impact Of The Policy-Practice Gap On Costs And Benefits Of Barrett'S Esophagus Management (Vol 115, Pg 1026, 2020)

RESULTS: Compared with no surveillance, the Dutch guideline incurred an additional (sic)4.7 ($5.3) million per 1,000 BE patients for surveillance and treatment, while 59 esophageal adenocarcinoma (EAC) cases (>T1a) were prevented. With intensive and very intensive surveillance strategies for both NDBE and LGD, the net costs increased by another (sic)2.3-6.0 ($2.6-6.8) million, while preventing 10-17 more EAC cases and gaining 29-48 more QALYs. On a population level, this amounted to (sic)19-50 ($22-57) million (+29%-77%) higher healthcare costs in 2017.DISCUSSION: The policy-practice gap in BE surveillance intervals results in 49%-128% higher net costs for BE management for only 9%-14% increase in QALYs gained, depending on actual intensity of surveillance. Incentives to eliminate this policy-practice gap should be developed to reduce the burden of BE management on patients and healthcare resources.