The cost-effectiveness of treatment strategies for achalasia

J. Barry O'Connor, Mendel E. Singer, Thomas Imperiale, Michael F. Vaezi, Joel E. Richter

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Achalasia is a disorder characterized by abnormal motility of the esophageal body and the lower esophageal sphincter, resulting in dysphagia, regurgitation, and chest pain. Treatment options for achalasia include Botulinum toxin injection, pneumatic balloon dilation, and surgical esophagomyotomy. The aim of this study was to determine the cost-effectiveness of these three strategies in the treatment of achalasia in adults. We constructed a Markov cost-effectiveness model comparing Botox injection, pneumatic balloon dilation, and laparoscopic esophagomyotomy as initial treatments of achalasia. Costs and probabilities were derived from the published literature. The utility for symptomatic achalasia was derived from a sample of patients with achalasia. Sensitivity analyses were performed. Over a five-year time horizon, pneumatic dilation was the most cost-effective treatment strategy for achalasia, with an incremental cost-effectiveness ratio of $1348 per quality-adjusted life-year compared to Botox. Although laparoscopic esophagomyotomy was more effective than the other treatment options, it was not cost-effective because of its high initial cost. In conclusion, pneumatic dilation is the most cost-effective treatment option for adults with achalasia. Further studies should examine the long-term relapse rates following treatment with Botox and more precisely determine the quality of life of symptomatic achalasia.

Original languageEnglish
Pages (from-to)1516-1525
Number of pages10
JournalDigestive Diseases and Sciences
Volume47
Issue number7
DOIs
StatePublished - 2002

Fingerprint

Esophageal Achalasia
Cost-Benefit Analysis
Dilatation
Therapeutics
Costs and Cost Analysis
Health Care Costs
Lower Esophageal Sphincter
Injections
Quality-Adjusted Life Years
Botulinum Toxins
Deglutition Disorders
Chest Pain
Quality of Life
Recurrence

Keywords

  • Achalasia
  • Cost-benefit analysis
  • Medical economics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

The cost-effectiveness of treatment strategies for achalasia. / O'Connor, J. Barry; Singer, Mendel E.; Imperiale, Thomas; Vaezi, Michael F.; Richter, Joel E.

In: Digestive Diseases and Sciences, Vol. 47, No. 7, 2002, p. 1516-1525.

Research output: Contribution to journalArticle

O'Connor, J. Barry ; Singer, Mendel E. ; Imperiale, Thomas ; Vaezi, Michael F. ; Richter, Joel E. / The cost-effectiveness of treatment strategies for achalasia. In: Digestive Diseases and Sciences. 2002 ; Vol. 47, No. 7. pp. 1516-1525.
@article{07bc08d480ab40b69ecc1643355d518a,
title = "The cost-effectiveness of treatment strategies for achalasia",
abstract = "Achalasia is a disorder characterized by abnormal motility of the esophageal body and the lower esophageal sphincter, resulting in dysphagia, regurgitation, and chest pain. Treatment options for achalasia include Botulinum toxin injection, pneumatic balloon dilation, and surgical esophagomyotomy. The aim of this study was to determine the cost-effectiveness of these three strategies in the treatment of achalasia in adults. We constructed a Markov cost-effectiveness model comparing Botox injection, pneumatic balloon dilation, and laparoscopic esophagomyotomy as initial treatments of achalasia. Costs and probabilities were derived from the published literature. The utility for symptomatic achalasia was derived from a sample of patients with achalasia. Sensitivity analyses were performed. Over a five-year time horizon, pneumatic dilation was the most cost-effective treatment strategy for achalasia, with an incremental cost-effectiveness ratio of $1348 per quality-adjusted life-year compared to Botox. Although laparoscopic esophagomyotomy was more effective than the other treatment options, it was not cost-effective because of its high initial cost. In conclusion, pneumatic dilation is the most cost-effective treatment option for adults with achalasia. Further studies should examine the long-term relapse rates following treatment with Botox and more precisely determine the quality of life of symptomatic achalasia.",
keywords = "Achalasia, Cost-benefit analysis, Medical economics",
author = "O'Connor, {J. Barry} and Singer, {Mendel E.} and Thomas Imperiale and Vaezi, {Michael F.} and Richter, {Joel E.}",
year = "2002",
doi = "10.1023/A:1015811001267",
language = "English",
volume = "47",
pages = "1516--1525",
journal = "Digestive Diseases and Sciences",
issn = "0163-2116",
publisher = "Springer New York",
number = "7",

}

TY - JOUR

T1 - The cost-effectiveness of treatment strategies for achalasia

AU - O'Connor, J. Barry

AU - Singer, Mendel E.

AU - Imperiale, Thomas

AU - Vaezi, Michael F.

AU - Richter, Joel E.

PY - 2002

Y1 - 2002

N2 - Achalasia is a disorder characterized by abnormal motility of the esophageal body and the lower esophageal sphincter, resulting in dysphagia, regurgitation, and chest pain. Treatment options for achalasia include Botulinum toxin injection, pneumatic balloon dilation, and surgical esophagomyotomy. The aim of this study was to determine the cost-effectiveness of these three strategies in the treatment of achalasia in adults. We constructed a Markov cost-effectiveness model comparing Botox injection, pneumatic balloon dilation, and laparoscopic esophagomyotomy as initial treatments of achalasia. Costs and probabilities were derived from the published literature. The utility for symptomatic achalasia was derived from a sample of patients with achalasia. Sensitivity analyses were performed. Over a five-year time horizon, pneumatic dilation was the most cost-effective treatment strategy for achalasia, with an incremental cost-effectiveness ratio of $1348 per quality-adjusted life-year compared to Botox. Although laparoscopic esophagomyotomy was more effective than the other treatment options, it was not cost-effective because of its high initial cost. In conclusion, pneumatic dilation is the most cost-effective treatment option for adults with achalasia. Further studies should examine the long-term relapse rates following treatment with Botox and more precisely determine the quality of life of symptomatic achalasia.

AB - Achalasia is a disorder characterized by abnormal motility of the esophageal body and the lower esophageal sphincter, resulting in dysphagia, regurgitation, and chest pain. Treatment options for achalasia include Botulinum toxin injection, pneumatic balloon dilation, and surgical esophagomyotomy. The aim of this study was to determine the cost-effectiveness of these three strategies in the treatment of achalasia in adults. We constructed a Markov cost-effectiveness model comparing Botox injection, pneumatic balloon dilation, and laparoscopic esophagomyotomy as initial treatments of achalasia. Costs and probabilities were derived from the published literature. The utility for symptomatic achalasia was derived from a sample of patients with achalasia. Sensitivity analyses were performed. Over a five-year time horizon, pneumatic dilation was the most cost-effective treatment strategy for achalasia, with an incremental cost-effectiveness ratio of $1348 per quality-adjusted life-year compared to Botox. Although laparoscopic esophagomyotomy was more effective than the other treatment options, it was not cost-effective because of its high initial cost. In conclusion, pneumatic dilation is the most cost-effective treatment option for adults with achalasia. Further studies should examine the long-term relapse rates following treatment with Botox and more precisely determine the quality of life of symptomatic achalasia.

KW - Achalasia

KW - Cost-benefit analysis

KW - Medical economics

UR - http://www.scopus.com/inward/record.url?scp=0036318456&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036318456&partnerID=8YFLogxK

U2 - 10.1023/A:1015811001267

DO - 10.1023/A:1015811001267

M3 - Article

VL - 47

SP - 1516

EP - 1525

JO - Digestive Diseases and Sciences

JF - Digestive Diseases and Sciences

SN - 0163-2116

IS - 7

ER -