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Surgical Endoscopy
Published in: Surgical Endoscopy 1/2018

01-01-2018

Cost-effectiveness of per oral endoscopic myotomy relative to laparoscopic Heller myotomy for the treatment of achalasia

Authors: Erin K. Greenleaf, MD, Joshua S. Winder, MD, Christopher S. Hollenbeak, PhD, Randy S. Haluck, MD, FACS, Abraham Mathew, MD, Eric M. Pauli, MD, FACS

Published in: Surgical Endoscopy | Issue 1/2018

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Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.
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Metadata
Title
Cost-effectiveness of per oral endoscopic myotomy relative to laparoscopic Heller myotomy for the treatment of achalasia
Authors
Erin K. Greenleaf, MD
Joshua S. Winder, MD
Christopher S. Hollenbeak, PhD
Randy S. Haluck, MD, FACS
Abraham Mathew, MD
Eric M. Pauli, MD, FACS
Publication date
01-01-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 1/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5629-3

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