Objective: To study the natural history of oesophageal adenocarcinoma in te
rms of utilization of the healthcare resources and associated medical costs
Methods: All 29 patients treated at the University of New Mexico Health Cen
ter between 1 January 1992 and 1 December 1998 for an oesophageal adenocarc
inoma were included in the study. For each individual patient, all medical
resources utilized, facility costs, and physician fees were retrieved from
the computerized databases of the collection departments.
Results: During the progress of the disease, the same type of diagnostic or
therapeutic procedure became necessary a number of times, and patients und
erwent, on average, three (range one to eight) upper gastrointestinal endos
copies, five (range one to 11) computerized tomography scans, 35 (five to 1
43) X-ray examinations, and 28 (three to 46) radiation therapies or 39 (10
to 74) chemotherapies. The large variation in the numbers of resources util
ized was also reflected by a corresponding variation in total healthcare co
sts. The mean cost per patient was $48 127, ranging between $13 454 and $13
9 721. Facility costs comprised 88% of all costs compared to physician fees
which comprised 12%. The largest cost items, in declining order, were phys
ician encounters ($16 916), radiation plus chemotherapy ($9909 plus $4891,
respectively), and pharmacy prescriptions ($7565).
Conclusions: The prolonged disease process and the many diagnostic and ther
apeutic procedures result in complications, side-effects, inconclusive test
s, or failed therapies that all markedly increase the use of healthcare res
ources. Because such outcomes are the rule rather than the exception, the m
anagement of oesophageal adenocarcinoma is expensive.