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©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
ARTICLE HIGHLIGHTS
Research background
Laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM) are two effective procedures for treating achalasia. Given the rising healthcare costs and their impact on patients and society, comparing their cost-effectiveness becomes crucial in determining the preferred management option. This research contrasts the initial procedure and short-term (1-year) costs of both techniques at a tertiary academic care center.
Research motivation
This study focuses on comparing the clinical outcomes and costs of LHM and POEM as treatments for achalasia. The key issue addressed is the lack of direct cost-effectiveness comparisons between these procedures despite their similar clinical efficacy. By demonstrating that POEM is not only clinically effective but also economically favorable due to shorter procedure times and hospital stays, this research contributes valuable insights for guiding future decisions in the management of achalasia, highlighting the importance of considering both clinical outcomes and cost factors in selecting treatment options.
Research objectives
This study’s primary aim was to compare clinical outcomes and costs between LHM and POEM for achalasia. The achieved objectives include demonstrating equivalent clinical efficacy and revealing cost advantages associated with POEM, attributed to shorter procedure times and hospital stays. These realized goals provide crucial insights for future research, emphasizing the need to consider both clinical effectiveness and economic implications when making treatment decisions for achalasia.
Research methods
The study employed a retrospective chart review method to achieve its objectives. Patient data from electronic medical records were analyzed to compare clinical outcomes and costs of LHM and POEM for achalasia. Novel aspects of the research methods included a detailed cost analysis that incorporated time-based operating room (OR) and anesthesia costs, along with a comprehensive examination of various cost categories. This approach provides a unique perspective on cost-effectiveness, highlighting the potential impact of shorter procedure times and hospital stays on overall costs.
Research results
The research findings underscored the comparable clinical efficacy of LHM and POEM for achalasia treatment, as evidenced by similar post-procedure Eckardt scores. Importantly, the study revealed a significant cost advantage of POEM over LHM, primarily attributed to shorter procedure times and hospital stays. This cost-effectiveness insight provides a valuable contribution to the field, highlighting the need for a holistic approach to treatment decisions. While the study addressed the immediate costs associated with the procedures, future research should delve into long-term cost patterns and their implications.
Research conclusions
The innovative aspect lies in its detailed cost analysis, incorporating time-based OR and anesthesia costs, and its emphasis on considering both clinical effectiveness and economic implications when making treatment decisions. While not introducing new methods, the study’s novelty comes from its comprehensive examination of cost categories and the recognition of the significance of shorter procedure times and hospital stays in influencing cost-effectiveness.
Research perspectives
The direction of future research in this field should encompass larger prospective studies with extended follow-up periods to validate the long-term cost-effectiveness and clinical outcomes of LHM and POEM procedures for achalasia. Additionally, investigating the evolving costs as POEM becomes more commonplace in endoscopy suites, as well as exploring variations in costs associated with individual achalasia subtypes, could provide valuable insights for informed treatment decisions.
