Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Direct cost variance analysis of peroral endoscopic myotomy vs heller myotomy for management of achalasia: A tertiary referral center experience
Syedreza Ali Haider, Gregory S Bills, C Prakash Gyawali, Passisd Laoveeravat, Jordan Miller, Samir Softic, Mihir S Wagh, Moamen Gabr
Syedreza Ali Haider, Department of Internal Medicine, Washington University School of Medicine St. Louis, St. Louis, MO 63018, United States
Gregory S Bills, Passisd Laoveeravat, Department of Digestive Disease and Nutrition, University of Kentucky College of Medicine, Lexington, KY 40508, United States
C Prakash Gyawali, Department of Internal Medicine, Washington University School of Medicine St. Louis and Barnes Jewish Hospital, St. Louis, MO 63108, United States
Jordan Miller, Department of Cardiothoracic Surgery, University of Kentucky College of Medicine, Lexington, KY 40508, United States
Samir Softic, Department of Pediatrics, University of Kentucky College of Medicine and Kentucky Children’s Hospital, Lexington, KY 40508, United States
Mihir S Wagh, Interventional Endoscopy, Division of Gastroenterology, University of Colorado School of Medicine, Aurora, CO 80045, United States
Moamen Gabr, Department of Advanced Endoscopy, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
Author contributions: Haider SA conducted primary data collection, performed data analysis, and took the lead in drafting the initial manuscript; Gyawali CP, Miller J, Softic S, and Wagh MS provided support in drafting the manuscript; Bills GS and Laoveeravat P participated in data collection, and also contributed to the study design; Gabr M played a role in shaping the overall study design, aiding in data collection, drafting the manuscript, and providing project leadership.
Institutional review board statement: The study protocol and data analysis described was approved by the University of Kentucky Institutional Review Board.
Informed consent statement: Given the retrospective nature of our study, informed consent was waived in concordance with University of Kentucky’s Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset related to the manuscript titled “Comparative Analysis of Laparoscopic Heller Myotomy and Per-oral Endoscopic Myotomy for Achalasia Treatment” are available from the corresponding author at
rha275@uky.edu. Informed consent was waived by the Institutional Review Board, and the presented data have been anonymized to minimize the risk of identification. The potential benefits of sharing these data outweigh the potential harms as the data contribute to scientific understanding and informed decision-making in the field of gastroenterology.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Moamen Gabr, FASGE, MD, MSc, Director, Department of Advanced Endoscopy, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA 02215, United States.
mgabr@bidmc.harvard.edu
Received: July 6, 2023
Peer-review started: July 6, 2023
First decision: August 4, 2023
Revised: August 23, 2023
Accepted: September 11, 2023
Article in press: September 11, 2023
Published online: October 16, 2023
Processing time: 96 Days and 0.1 Hours
BACKGROUND
Laparoscopic Heller myotomy (LHM) has been the traditional surgical treatment for achalasia. Recently, peroral endoscopic myotomy (POEM) has demonstrated similar clinical outcomes with shorter procedure times. Studies comparing the direct cost-effectiveness of POEM vs LHM are limited.
AIM
To compare costs of POEM vs LHM.
METHODS
This retrospective chart review aimed to compare the outcomes and cost of clinical care between patients who underwent POEM and LHM procedures for achalasia. The study was conducted at a tertiary academic center from January 2019 to December 2020. Clinical outcomes, including post-operative Eckardt scores and adverse events, were assessed and compared between the two groups. Direct cost variance analysis was utilized to evaluate the cost of clinical care incurred by patients undergoing POEM in the year preceding the procedure, during the index admission, and one year post-procedure, in comparison to patients undergoing LHM.
RESULTS
Of 30 patients were included (15 POEM and 15 LHM) in the study. Patients in the POEM group had a mean Eckardt score of 0.5 ± 0.5 post-procedure, which was no different from patients in the LHM group (0.7 ± 0.6, P = 0.17) indicating comparative efficacy. However, the total costs of the admission for the procedure in the LHM group were on average $1827 more expensive than in the POEM group (P < 0.01). Total healthcare costs one year prior to index procedure were $7777 higher in the LHM group, but not statistically different (P = 0.34). The patients in the LHM group one year after the index procedure had accrued $19730.24 larger total cost, although this was not statistically different from POEM group (P = 0.68).
CONCLUSION
Despite similar clinical outcomes, the cost of the index procedure admission for POEM was significantly lower than for LHM. The difference was primarily related to shorter time increments utilized in the operating room during the index procedure, and shorter length of hospital stay following POEM.
Core Tip: This manuscript focuses on comparing the clinical outcomes and costs of laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM) as treatment options for achalasia, a rare esophageal motility disorder. Achalasia is characterized by impaired relaxation of the lower esophageal sphincter and abnormal peristalsis in the esophageal body, resulting in symptoms such as dysphagia, regurgitation, chest pain, and weight loss. The study aims to determine the clinical efficacy and cost-effectiveness of both procedures. By analyzing data from a tertiary-academic referral center, the researchers investigate the clinical outcomes, costs prior to and following the procedure, and adverse events associated with LHM and POEM.
