Cost-Effectiveness of Aspirin Chemoprevention for Barrett’s Esophagus

Background: Recent data suggest that nonsteroidal anti-inflammatory drugs, including aspirin, may prevent the pro-gression of Barrett’s esophagus to adenocarcinoma. How-ever, use of aspirin is associated with numerous potential complications, including gastrointestinal bleeding and hem-orrhagic strokes. We used a modeling approach to determine and compare the effectiveness and cost-effectiveness of aspi-rin with and without endoscopic surveillance to prevent esophageal adenocarcinoma. Methods: A Markov Monte Carlo decision model was constructed to compare four strat-egies for management of Barrett’s esophagus: aspirin ther-apy, endoscopic surveillance with biopsies, both, or neither. Patients who took a daily enteric-coated aspirin were mod-eled to have a 50 % reduction in the incidence of esophageal adenocarcinoma but could have complications related t