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- Title
Cost-effectiveness of per oral endoscopic myotomy relative to laparoscopic Heller myotomy for the treatment of achalasia.
- Authors
Greenleaf, Erin K.; Winder, Joshua S.; Hollenbeak, Christopher S.; Haluck, Randy S.; Mathew, Abraham; Pauli, Eric M.
- Abstract
<bold>Background: </bold>Per oral endoscopic myotomy (POEM) has recently emerged as a viable option relative to the classic approach of laparoscopic Heller myotomy (LHM) for the treatment of esophageal achalasia. In this cost-utility analysis of POEM and LHM, we hypothesized that POEM would be cost-effective relative to LHM.<bold>Methods: </bold>A stochastic cost-utility analysis of treatment for achalasia was performed to determine the cost-effectiveness of POEM relative to LHM. Costs were estimated from the provider perspective and obtained from our institution's cost-accounting database. The measure of effectiveness was quality-adjusted life years (QALYs) which were estimated from direct elicitation of utility using a visual analog scale. The primary outcome was the incremental cost-effectiveness ratio (ICER). Uncertainty was assessed by bootstrapping the sample and computing the cost-effectiveness acceptability curve (CEAC).<bold>Results: </bold>Patients treated within an 11-year period (2004-2016) were recruited for participation (20 POEM, 21 LHM). During the index admission, the mean costs for POEM ($8630 ± $2653) and the mean costs for LHM ($7604 ± $2091) were not significantly different (P = 0.179). Additionally, mean QALYs for POEM (0.413 ± 0.248) were higher than that associated with LHM (0.357 ± 0.338), but this difference was also not statistically significant (P = 0.55). The ICER suggested that it would cost an additional $18,536 for each QALY gained using POEM. There was substantial uncertainty in the ICER; there was a 48.25% probability that POEM was cost-effective at the mean ICER. At a willingness-to-pay threshold of $100,000, there was a 68.31% probability that POEM was cost-effective relative to LHM.<bold>Conclusions: </bold>In the treatment of achalasia, POEM appears to be cost-effective relative to LHM depending on one's willingness-to-pay for an additional QALY.
- Subjects
ESOPHAGEAL achalasia; MUSCLES; COST effectiveness; MEDICAL care costs; SURGERY; THERAPEUTICS; MEDICAL care cost statistics; ENDOSCOPY; HOSPITAL care; LENGTH of stay in hospitals; LAPAROSCOPY; VISUAL analog scale; TREATMENT effectiveness; RETROSPECTIVE studies; QUALITY-adjusted life years
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2018, Vol 32, Issue 1, p39
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-017-5629-3