Trends in management and healthcare resource utilization for achalasia following adoption of per-oral endoscopic myotomy.

BACKGROUND

Per-oral endoscopic myotomy (POEM), Heller myotomy (HM), and pneumatic dilation (PD) offer definitive interventions of achalasia, but comparative analysis of long-term healthcare resource utilization is not well described. This study explores longitudinal trends and one-year post-procedure healthcare resource utilization in Indiana following local adoption of POEM in 2014.

METHODS

This multicenter retrospective statewide cohort study utilized relevant ICD-9, ICD-10, and CPT codes to identify all patients with achalasia who underwent definitive index disease intervention with POEM, HM (laparoscopic HM alone or LHM with intraoperative conversion to open myotomy) or PD between January 2008 and November 2022 with ≥ 1 year follow-up. Multivariate logistic regression was utilized to determine post-intervention healthcare resource utilization. Temporizing interventions were defined as < 30 mm balloon dilation or Botox injections.

RESULTS

621 patients who underwent POEM (n = 363, mean age 54.18 years, 39% female), HM (n = 246, mean age: 48.71 years, 47% female), and PD (n = 12, mean age 52.75 years, 50% female) from two tertiary centers in Indiana were identified. From 2014 to 2022, the use of POEM increased 31-fold, while the use of HM decreased 19-fold between 2008 and 2022. Within one year of treatment, POEM was associated with less definitive reintervention compared to HM (OR 0.10, 95% CI 0.01-0.62, p = 0.01) or PD (OR 0.002, 95% CI 0.0001-0.023, p < 0.001) but more diagnostic testing than HM (OR 20.9, 95%CI 10.8, 40.4, p < 0.001). Hospital utilization within 30 days, temporizing interventions within one year, and the frequency of adverse events were similar.

CONCLUSIONS

During the study period, use of POEM increased 31-fold while use of HM decreased 19-fold. POEM was associated with increased healthcare resource utilization, more post-procedure testing, lower odds of definitive disease reintervention, and similar rates of adverse events compared to HM and PD.