Valuing innovative endoscopic techniques: per-oral endoscopic myotomy for the management of achalasia Eric D. Shah, MD, MBA, Andrew C. Chang, MD, Ryan.

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Presentation transcript:

Valuing innovative endoscopic techniques: per-oral endoscopic myotomy for the management of achalasia Eric D. Shah, MD, MBA, Andrew C. Chang, MD, Ryan Law, DO Gastrointestinal Endoscopy Volume 89, Issue 2, Pages 264-273.e3 (February 2019) DOI: 10.1016/j.gie.2018.04.2341 Copyright © 2019 Terms and Conditions

Figure 1 Model diagram. Gastrointestinal Endoscopy 2019 89, 264-273.e3DOI: (10.1016/j.gie.2018.04.2341) Copyright © 2019 Terms and Conditions

Figure 2 Probabilistic sensitivity analysis to determine the probability of POEM being more cost-effective than LHM based on reimbursement (in total RVU assignment) for POEM. POEM remains cost-effective at contemporary willingness-to-pay thresholds at RVU assignments exceeding those of other endoscopic procedures. LHM, Laparoscopic Heller myotomy; RVU, relative value unit; POEM, per-oral endoscopic myotomy. Gastrointestinal Endoscopy 2019 89, 264-273.e3DOI: (10.1016/j.gie.2018.04.2341) Copyright © 2019 Terms and Conditions

Figure 3 Sensitivity analysis evaluating the preferred treatment strategy by varying the postprocedural rates of clinically significant GERD after POEM and LHM and proposed reimbursement for POEM. Dark gray represents POEM as the preferred treatment strategy using the assigned model inputs. Light gray represents LHM as the preferred treatment strategy. Data are presented at willingness-to-pay (WTP) levels of $50,000 (top row) and $100,000 (bottom row) per quality-adjusted life year. LHM, Laparoscopic Heller myotomy; POEM, per-oral endoscopic myotomy. Gastrointestinal Endoscopy 2019 89, 264-273.e3DOI: (10.1016/j.gie.2018.04.2341) Copyright © 2019 Terms and Conditions

Figure 4 Sensitivity analysis evaluating the preferred treatment strategy by varying the postprocedural rates of manometric-confirmed reflux after POEM and LHM in cost-minimization analysis (top panel) or cost-effectiveness analysis (bottom panel). In this analysis, manometric-confirmed reflux was assumed to be clinically significant. Dark gray represents POEM as the preferred treatment strategy using the assigned model inputs. Light gray represents LHM as the preferred treatment strategy. POEM was the preferred treatment strategy independent of postprocedural reflux at reimbursement levels similar to advanced endoscopic procedures (left panel) or with 20% cost savings compared with LHM in cost-minimization analysis (center top). With 20% cost savings with POEM compared with LHM, preference for procedure depended on postprocedural rates of reflux in cost-effectiveness analysis (center bottom). In a scenario assuming no difference in reimbursement between LHM and POEM (right panel), LHM was generally the preferred treatment strategy except at low rates of reflux with POEM and high rates of heartburn with LHM in cost-effectiveness analysis. LHM, Laparoscopic Heller myotomy; POEM, per-oral endoscopic myotomy. Gastrointestinal Endoscopy 2019 89, 264-273.e3DOI: (10.1016/j.gie.2018.04.2341) Copyright © 2019 Terms and Conditions

Supplementary Figure 1 Full model diagram. Gastrointestinal Endoscopy 2019 89, 264-273.e3DOI: (10.1016/j.gie.2018.04.2341) Copyright © 2019 Terms and Conditions

Supplementary Figure 2 Sensitivity analysis evaluating the impact of risk of perforation/bleeding requiring conversion to an open procedure on preferred treatment strategy (WTP = $100,000/QALY) using a 1-year time horizon. To enable analysis, reimbursement for POEM was set at the maximum cost-effective reimbursement level corresponding to a WTP threshold of $100,000. POEM, Per-oral endoscopic myotomy; QALY, quality-adjusted life year; WTP, willingness to pay. Gastrointestinal Endoscopy 2019 89, 264-273.e3DOI: (10.1016/j.gie.2018.04.2341) Copyright © 2019 Terms and Conditions