RESPONSE: Re: Cost-Effectiveness of Aspirin Chemoprevention for Barrett's Esophagus

Extract

We thank Drs. Jankowski and Moayyedi for their comments and agree that chemoprevention for Barrett's esophagus is an extremely timely issue. Our disease model of Barrett's esophagus found that aspirin chemoprevention could be a cost-effective management tool for a patient with Barrett's esophagus. However, as we acknowledged in our discussion, the principal limitation of the model's findings involved the uncertainty that surrounds many of the parameter estimates used to depict the natural history of Barrett's esophagus. Because the progression of Barrett's esophagus to esophageal adenocarcinoma occurs in a small percentage of patients and over a long period, the logistical barriers to performing a rigorous clinical trial that is sufficiently large and with adequate follow-up have prevented such a study until now. This lack of randomized controlled trial data has created a vacuum in our understanding of the natural history of Barrett's esophagus.

We applaud Drs. Jankowski and Moayyedi for their ambitious randomized controlled trial that has already started enrolling patients. Their trial appears to be a prodigious undertaking but should provide much-needed information on the natural history of Barrett's esophagus and chemoprevention that has largely been extrapolated from retrospective or small, observational type studies.