PDF(Pubmed)
Abstract：
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.
OBJECTIVE: 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).
CONCLUSIONS: 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.
OBJECTIVE: 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).
CONCLUSIONS: 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.
摘要：
背景：腹腔镜Heller肌切开术（LHM）已成为贲门失弛缓症的传统手术治疗方法。最近,经口内镜下肌切开术(POEM)显示出相似的临床结果,手术时间较短.比较POEM与LHM的直接成本效益的研究有限。
目的：比较POEM与LHM的成本。
方法：本回顾性图表旨在比较接受POEM和LHM手术的贲门失弛缓症患者的临床治疗结果和费用。该研究于2019年1月至2020年12月在三级学术中心进行。临床结果,包括术后Eckardt评分和不良事件，对两组进行评估和比较。直接成本差异分析用于评估手术前一年接受POEM的患者所产生的临床护理成本。在索引录取期间，手术后一年，与接受LHM的患者相比。
结果：研究中纳入了30名患者（15名POEM和15名LHM）。POEM组患者术后平均Eckardt评分为0.5±0.5，这与LHM组的患者没有差异（0.7±0.6，P=0.17），表明比较疗效。然而,LHM组手术的总费用平均比POEM组贵1827美元(P<0.01).LHM组的索引程序前一年的总医疗保健费用高出7777美元，但无统计学差异(P=0.34)。LHM组中的患者在索引程序后一年累积了19730.24美元的总费用，尽管这与POEM组没有统计学差异(P=0.68)。
结论：尽管临床结果相似，POEM的索引程序入院成本明显低于LHM。差异主要与索引程序期间手术室使用的较短时间增量有关，POEM后住院时间缩短。
目的：比较POEM与LHM的成本。
方法：本回顾性图表旨在比较接受POEM和LHM手术的贲门失弛缓症患者的临床治疗结果和费用。该研究于2019年1月至2020年12月在三级学术中心进行。临床结果,包括术后Eckardt评分和不良事件，对两组进行评估和比较。直接成本差异分析用于评估手术前一年接受POEM的患者所产生的临床护理成本。在索引录取期间，手术后一年，与接受LHM的患者相比。
结果：研究中纳入了30名患者（15名POEM和15名LHM）。POEM组患者术后平均Eckardt评分为0.5±0.5，这与LHM组的患者没有差异（0.7±0.6，P=0.17），表明比较疗效。然而,LHM组手术的总费用平均比POEM组贵1827美元(P<0.01).LHM组的索引程序前一年的总医疗保健费用高出7777美元，但无统计学差异(P=0.34)。LHM组中的患者在索引程序后一年累积了19730.24美元的总费用，尽管这与POEM组没有统计学差异(P=0.68)。
结论：尽管临床结果相似，POEM的索引程序入院成本明显低于LHM。差异主要与索引程序期间手术室使用的较短时间增量有关，POEM后住院时间缩短。
