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

Table 1 Baseline characteristics of peroral endoscopic myotomy and laparoscopic Heller myotomy patients at time of intervention

	POEM (n = 15)	LHM (n = 15)	P value
Mean age in years (SD)	54.2 (8.6)	52.6 (7.3)	0.74
Gender (% female)	53	53	1.0
Mean weight (lbs, standard deviation)	183.3 (47)	188.4 (25.3)	0.26
Mean duration of symptoms (yr, SD)	7.1 (6.8)	7.3 (7.1)	0.78
Achalasia subtype1	4/7/3/1	4/8/1/2	0.70
Prior botulinum toxin	4	3	0.70
Pneumatic dilation	7	7	1.0
Mean Eckardt score (SD)	7.0 (2.9)	5.8 (2.6)	0.25
Symptom Score > 2, %
Weight loss	67	73	1
Dysphagia	73	73	1
Regurgitation	67	80	0.67
Chest pain	20	20	1

¹Type 1/type 2/type 3/hypercontractile esophagus.

POEM: Peroral endoscopic myotomy; LHM: Laparoscopic Heller myotomy.

Table 2 Patient outcomes following peroral endoscopic myotomy and laparoscopic Heller myotomy

	POEM (n = 15)	LHM (n = 15)	P value
Post-procedure Eckardt Scores mean (SD)	0.5 (0.5)	0.7 (0.6)	0.17
Adverse events (n, %)	2, 13.3%	4, 26.7%	0.65
Readmission rate (% of patients with readmission within one year)	6.7%	20.0%	0.59
LOS mean days (SD)	1.1 (0.3)	2.26 (0.6)	< 0.01a

^aDenotes statistical significance at P-value < 0.05.

LOS: Length of stay; POEM: Peroral endoscopic myotomy; LHM: Laparoscopic Heller myotomy.

Table 3 Comparison of costs

Cost category	Total direct cost variance (LHM - POEM)	Average total direct cost variance	P value
Total direct cost variance of index admission	$27417	$1827.81	< 0.01
Anesthesia	$1322 ± 14	$88.10	0.05
EKG/telemetry	$5 ± 5	$0.3 ± 8	0.08
Laboratory	$1047 ± 32	$70 ± 116	0.05
Medical surgical supplies	$8297 ± 848	$553 ± 649	0.07
Pre-operative costs	$67 ± 17	$5 ± 13	0.84
OR services	$8169 ± 326	$545 ± 404	< 0.01
Time spent in ICU/observation	$2781 ± 303	$185 ± 509	< 0.01
Ancillary services	$166 ± 12	$11 ± 22	0.18
Cardiac services	$107 ± 4	$7 ± 10	0.13
Specialty diagnostic services	$25 ± 0.3	$2 ± 0.3	0.12
PACU costs	$70 ± 78	$46 ± 49	0.74
Pharmacy and IV therapy	$1860 ± 33	$124 ± 130	< 0.01
Physical therapy	$223 ± 13	$15 ± 1	< 0.01
Respiratory	$71 ± 71	$5 ± 65	0.76
Routine accommodations	$4377 ± 431	$292 ± 461	0.75
X-Ray	$1.117 ± 37	$75 ± 66	< 0.01
1 yr prior to index procedure	$7777	$513	0.34
1 yr after index procedure	$19730	$1315	0.68

Costs are rounded to the nearest dollar value whenever possible. POEM: Peroral endoscopic myotomy; LHM: Laparoscopic Heller myotomy; EKG: Electrocardiographic; OR: Operating room; ICU: Intensive care unit; PACU: Postanesthesia care unit.