Direct cost variance analysis of peroral endoscopic myotomy vs heller myotomy for management of achalasia:A tertiary referral center experience  

作　　者：Syedreza Ali Haider Gregory S Bills C Prakash Gyawali Passisd Laoveeravat Jordan Miller Samir Softic Mihir S Wagh Moamen Gabr 

机构地区：[1]Department of Internal Medicine,Washington University School of Medicine St.Louis,St.Louis,MO 63018,United States [2]Department of Digestive Disease and Nutrition,University of Kentucky College of Medicine,Lexington,KY 40508,United States [3]Department of Internal Medicine,Washington University School of Medicine St.Louis and Barnes Jewish Hospital,St.Louis,MO 63108,United States [4]Department of Cardiothoracic Surgery,University of Kentucky College of Medicine,Lexington,KY 40508,United States [5]Department of Pediatrics,University of Kentucky College of Medicine and Kentucky Children’s Hospital,Lexington,KY 40508,United States [6]Interventional Endoscopy,Division of Gastroenterology,University of Colorado School of Medicine,Aurora,CO 80045,United States [7]Department of Advanced Endoscopy,Beth Israel Deaconess Medical Center,Boston,MA 02215,United States

出　　处：《World Journal of Gastrointestinal Endoscopy》2023年第10期593-601,共9页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：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 Haider SA et al.Comparing costs:POEM vs Heller myotomy WJGE https://www.wjgnet.com 594 October 16,2023 Volume 15 Issue 10 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 lengt

关 键 词：Peroral endoscopic myotomy Cost analysis Laparoscopic Heller myotomy ACHALASIA 

分 类 号：R655.4[医药卫生—外科学]