OBJECTIVES: An estimated 17 million people in the US have Barrett’s Esophagus (BE), a precursor to esophageal cancer (EAC). The low probability of progressing to EAC (less than 2%) and the inability of standard histopathology to risk stratify BE patients have resulted in inefficient surveillance protocols and calls for effective innovation to identify higher risk patients. A newly-developed biomarker test can risk stratify BE patients for progression to high grade dysplasia (HGD) and EAC. The test stratifies patients into high, medium and low risk categories, giving providers actionable information for BE endoscopy surveillance frequency and treatment decisions such as radiofrequency ablation (RFA).  This study evaluates the cost-effectiveness of this new biomarker test compared with the current standard of care (SOC) surveillance and treatment of BE. METHODS: Decision analysis with Markov modeling and cohort simulation were used to model treatment costs and outcomes from a health plan perspective. Costs were derived from Geisinger Health Plan claims data and quality-adjusted life-years (QALYs) from the medical literature.  The model includes realistic assumptions for physician adherence to SOC for patients in each risk category. RESULTS: Preliminary results of a 5 year model of using the new biomarker test compared to SOC include an incremental cost-effectiveness ratio of $75,804 in U.S. 2012 dollars.  Cumulative endoscopies in the biomarker test arm were 6.23% greater than with SOC and there were 73.3% fewer cumulative RFAs under SOC than with the biomarker test. Compared with SOC, the number of patients in the HGD, EAC, and death states in the biomarker test arm were 52.5%, 60.9% and 9.83% fewer, respectively. CONCLUSIONS: Using this new biomarker test to risk stratify BE patients is cost-effective at the $100,000 threshold and, due to more effective surveillance and treatment protocols, results in fewer patients transitioning to HGD, EAC, and death.