Wide Area Transepithelial Sampling with Computer-Assisted Analysis (WATS^3D) Is Cost-Effective in Barrett’s Esophagus Screening

Background: Wide area transepithelial sampling with three-dimensional computer-assisted analysis (WATS^3D) is an adjunct to the standard random 4-quadrant forceps biopsies (FB, “Seattle protocol”) that significantly increases the detection of Barrett’s esophagus (BE) and associated neoplasia in patients undergoing screening or surveillance. Aims: To examine the cost-effectiveness of adding WATS^3D to the Seattle protocol in screening patients for BE. Methods: A decision analytic model was used to compare the effectiveness and cost-effectiveness of two alternative BE screening strategies in chronic gastroesophageal reflux disease patients: FB with and without WATS^3D. The reference case was a 60-year-old white male with gastroesophageal reflux disease (GERD). Effectiveness was measured by the number needed to screen to avert one cancer and one cancer-related death, and quality-adjusted life years (QALYs). Cost was measured in 2019 US$, and the incremental cost-effectiveness ratio (ICER) was measured in $/QALY using thresholds for cost-effectiveness of $100,000/QALY and $150,000/QALY. Cost was measured in 2019 US$. Cost and QALYs were discounted at 3% per year. Results: Between 320 and 337 people would need to be screened with WATS^3D in addition to FB to avert one additional cancer, and 328–367 people to avert one cancer-related death. Screening with WATS^3D costs an additional $1219 and produced an additional 0.017 QALYs, for an ICER of $71,395/QALY. All one-way sensitivity analyses resulted in ICERs under $84,000/QALY. Conclusions: Screening for BE in 60-year-old white male GERD patients is more cost-effective when WATS^3D is used adjunctively to the Seattle protocol than with the Seattle protocol alone.