Incidental downstream resource utilization due to endoscopic screening for Barrett's esophagus

Cost-effectiveness analyses have demonstrated benefit in screening for Barrett's esophagus (BE) but have not included resource utilization due to incidental findings. We abstracted longitudinal data from a study of male patients aged 50-79 years undergoing research esophagogastroduodenoscopy (EGD) for BE screening regardless of symptoms. Patients were enrolled at the time colonoscopy for colorectal cancer screening at two facilities. Costs were estimated from Centers for Medicare and Medicaid Services median national reimbursements and average wholesale prices of medications. Of 822 men enrolled, almost one-third of patients had gastric biopsies obtained (32.4%) and an additional 15.7% were recommended acid suppression. Repeat EGD was recommended in only 2.0% of patients, but was the second most costly weighted resource. The total additional expected cost due to incidental findings was $66 per EGD. We conclude that incidental findings during EGD for BE leads to a modest increase in resource utilization, primarily due to biopsies and acid suppression, which should be considered in future cost-effectiveness analyses.