Department of Gastroenterology, Catholic University of Leuven, Leuven, Belgium.
Gastrointestinal Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Neurogastroenterol Motil. 2017 Nov;29(11). doi: 10.1111/nmo.13115. Epub 2017 May 25.
A recent multicenter randomized trial in achalasia patients has shown that pneumatic dilation resulted in equivalent relief of symptoms compared to laparoscopic Heller myotomy. Additionally, the cost of each treatment should be also taken in consideration. Therefore, the aim of the present study was to perform an economic analysis of the European achalasia trial.
Patients with newly diagnosed achalasia were enrolled from to 2003 to 2008 in 14 centers in five European countries and were randomly assigned to either pneumatic dilation (PD) or laparoscopic Heller (LHM). The economic analysis was performed in the three centers in three different countries where most patients were enrolled (Amsterdam [NL], Leuven, [B] and Padova [I]) and then applied to all patients included in the study. The total raw costs of the two treatments per patient include the initial costs, the costs of complications, and the costs of retreatments.
Two hundred and one patients, 107 (57 males and 50 females, mean age 46 CI: 43-49 years) were randomized to LHM and 94 (59 males and 34 females, mean age 46 CI 43-50 years) to PD. The total cost of PD per patient was quite comparable in the three different centers; €3397 in Padova, €3259 in Amsterdam and €3792 in Leuven. For LHM, the total costs per patient were highest in Amsterdam: €4488 in Padova, €6720 in Amsterdam, and €5856 in Leuven.
In conclusion, the strategy of treating achalasia starting with PD appears the most economic approach, independent of the health system.
最近一项关于贲门失弛缓症患者的多中心随机试验表明，与腹腔镜 Heller 肌切开术相比，气囊扩张在缓解症状方面效果相当。此外，还应考虑每种治疗方法的成本。因此，本研究旨在对欧洲贲门失弛缓症试验进行经济分析。
2003 年至 2008 年，14 家欧洲中心的 201 名新诊断为贲门失弛缓症的患者被纳入研究，并随机分为气囊扩张（PD）组或腹腔镜 Heller 肌切开术（LHM）组。经济分析在三个中心进行，这些中心位于三个不同的国家，大多数患者都在这些中心接受治疗（阿姆斯特丹[NL]、鲁汶[B]和帕多瓦[I]），然后将这些结果应用于所有纳入研究的患者。两种治疗方法的每位患者总费用包括初始费用、并发症费用和再治疗费用。
201 名患者，107 名（57 名男性和 50 名女性，平均年龄 46 岁，置信区间：43-49 岁）被随机分配到 LHM 组，94 名（59 名男性和 34 名女性，平均年龄 46 岁，置信区间：43-50 岁）被分配到 PD 组。在三个不同的中心，PD 每位患者的总费用相当接近；帕多瓦为 3397 欧元，阿姆斯特丹为 3259 欧元，鲁汶为 3792 欧元。对于 LHM，每位患者的总费用在阿姆斯特丹最高：帕多瓦为 4488 欧元，阿姆斯特丹为 6720 欧元，鲁汶为 5856 欧元。
总之，与腹腔镜 Heller 肌切开术相比，起始时采用 PD 治疗贲门失弛缓症的策略是最经济的方法，与卫生系统无关。
