Economic Impact of Per Oral Endoscopic Myotomy Versus Laparoscopic Heller Myotomy and Endoscopic Pneumatic Dilation

Michael P Meara, MD, MBA, Kyle A Perry, MD, Jeffery W Hazey, MD. The Ohio State University Wexner Medical Center.

BACKGROUND: Per Oral Endoscopic Myotomy (POEM) has proven to be a viable therapeutic modality for the treatment of idiopathic achalasia. Cost data has not been reported which evaluates the cost of POEM. The purpose of this study was to retrospectively collect and compare cost data for laparoscopic myotomy (LM), POEM, and pneumatic dilation (PD).

METHODS: A single institution retrospective review of patients undergoing therapy for achalasia from January 1, 2007 to August 31st, 2013 was performed. Professional fees and hospital charges were collected. Professional and facility charges were obtained for LMs coded under Current Procedural Terminology (CPT) 43279 (Laparoscopy, surgical, esophagomyotomy (Heller type), with fundoplasty, when performed). This included the overnight hospital stay and Gastrografin swallow study. Professional and facility charges were obtained for POEMs coded under CPT 43499 (Unlisted procedure, esophagus). This included the overnight hospital stay and Gastrografin swallow study. Professional and facility charges were obtained for PDs coded under CPT 43249 (Upper gastrointestinal endoscopy with balloon dilation of esophagus). All charges were then adjusted for inflation utilizing the Consumer Price Index.

RESULTS: One-hundred-and-thirteen patients underwent treatment for achalasia during the study period. Total charges, including professional fees and total hospital charges, were collected for LM (n=95), POEM (n=18), and PD (n=13). Laparoscopic Heller myotomies were charged on average $44,839 while Per Oral Endoscopic Myotomies comparably cost $41,730. Representative dilation cost was found to be $9,190 per episode of endoscopic outpatient dilation. For serial dilations, cost savings was realized for LMs at 4.87 dilations and realized for POEMs at 4.54 dilations.

CONCLUSIONS: Retrospective financial analysis reveals that the operative cost of POEM is similar to that of LM. In the absence of serious complications, pneumatic dilation remains less costly than surgical myotomy when fewer than four treatments are required. As experience with POEM increases, its cost may decrease, particularly if it can be safely performed as an outpatient procedure.

KEY WORDS: Achalasia — Laparoscopic Heller Myotomy — Per Oral Endoscopic Myotomy — POEM — Pneumatic Balloon dilatation — Myotomy — Cost — Laparoscopy
 

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