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

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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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Authors and Affiliations

  1. Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, H151, Hershey, PA, 17033-0850, USA

    Erin K. Greenleaf MD, Joshua S. Winder MD, Christopher S. Hollenbeak PhD, Randy S. Haluck MD, FACS & Eric M. Pauli MD, FACS

  2. Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, 500 University Drive, H151, Hershey, PA, 17033-0850, USA

    Christopher S. Hollenbeak PhD

  3. Department of Internal Medicine, The Pennsylvania State University, College of Medicine, 500 University Drive, H151, Hershey, PA, 17033-0850, USA

    Abraham Mathew MD

Authors
  1. Erin K. Greenleaf MD
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  2. Joshua S. Winder MD
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  3. Christopher S. Hollenbeak PhD
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  4. Randy S. Haluck MD, FACS
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  5. Abraham Mathew MD
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  6. Eric M. Pauli MD, FACS
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Corresponding author

Correspondence to Christopher S. Hollenbeak PhD.

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Disclosure

Drs. Greenleaf, Winder, Hollenbeak, Haluck, Mathew and Pauli have no conflicts of interest or financial ties to disclose.

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Greenleaf, E.K., Winder, J.S., Hollenbeak, C.S. et al. Cost-effectiveness of per oral endoscopic myotomy relative to laparoscopic Heller myotomy for the treatment of achalasia. Surg Endosc 32, 39–45 (2018). https://doi.org/10.1007/s00464-017-5629-3

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  • DOI: https://doi.org/10.1007/s00464-017-5629-3

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