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Published on: November 9, 2016
Intrasphincteric botulinum toxin versus pneumatic dilatation for achalasia: a cost minimization analysis
R Panaccione1, J C Gregor, R P Reynolds
1Division of Gastroenterology, Department of Medicine, The University of Western Ontario, London, Ontario, Canada.
Gastrointestinal Endoscopy
|September 29, 1999
Summary
Pneumatic dilatation is a more cost-effective treatment for achalasia than intrasphincteric botulinum toxin injection. The higher cost of repeated botulinum toxin injections outweighs its safety benefits unless life expectancy is very short.
Area of Science:
- Gastroenterology
- Medical Economics
Background:
- Achalasia treatment options include pneumatic dilatation and intrasphincteric botulinum toxin injection.
- Intrasphincteric botulinum toxin injection offers safety but may require frequent re-treatment.
- Pneumatic dilatation provides longer-lasting relief but carries a risk of esophageal perforation.
Purpose of the Study:
- To compare the treatment costs of pneumatic dilatation and intrasphincteric botulinum toxin injection for achalasia.
- To determine if the practical advantages of botulinum toxin injection justify its economic impact due to re-treatment.
Main Methods:
- A decision analysis model was used to compare treatment costs.
- Probability estimates for botulinum toxin injection were sourced from published data.
- Pneumatic dilatation data were gathered from a 10-year retrospective review using the Rigiflex dilator.
Main Results:
- Intrasphincteric botulinum toxin injection cost $5033 over 10 years, compared to $3608 for pneumatic dilatation.
- Pneumatic dilatation remained less expensive across all sensitivity analyses of costs and probabilities.
- Botulinum toxin injection was only more cost-effective if life expectancy was less than 2 years.
Conclusions:
- Intrasphincteric botulinum toxin injection is more expensive than pneumatic dilatation for achalasia treatment.
- The frequent re-treatment costs for botulinum toxin injection generally outweigh its safety benefits.
- Pneumatic dilatation is the more economical choice for achalasia management, except in cases with very limited life expectancy.
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