Botulinum toxin injection vs laparoscopic myotomy for the treatment of esophageal achalasia: Economic analysis of a randomized trial

G. Zaninotto, V. Vergadoro, V. Annese, M. Costantini, M. Costantino, D. Molena, C. Rizzetto, M. Epifani, A. Ruol, L. Nicoletti, E. Ancona

Research output: Contribution to journalArticle

Abstract

Background: The treatment of esophageal achalasia is still controversial: current therapies are palliative and aim to relieve dysphagia by disrupting or relaxing the lower esophageal sphincter muscle fibers with botulinum toxin. The aim of this study was to compare the clinical and economic results of two such treatments: laparoscopic myotomy and botulinum toxin injection. Methods: A total of 37 patients with esophageal achalasia were randomly assigned to receive laparoscopic myotomy (20) or two Botox injections 1 month apart (17). All patients were treated at the same hospital and were part of a larger multicenter study. Symptom score, lower esophageal sphincter pressure, and esophageal diameter at barium swallow were compared. The economic analysis was performed considering only the direct costs (cost per treatment and cost effectiveness, i.e., cost per patient healed). Results: Mortality and morbidity were nil in both groups. The actuarial probability of being asymptomatic at 2 years was 90% for surgery and 34% for Botox (p <0.05). The initial cost was lower for Botox (€1,245) than for surgery (€3,555), but when cost effectiveness at 2 years was considered, this difference nearly disappeared: Botox €3,364, surgery €3,950. Conclusion: Botox is still the least costly treatment, but the minimal difference in the longer term does not justify its use, given that surgery is a risk-free, definitive treatment.

Original languageEnglish (US)
Pages (from-to)691-695
Number of pages5
JournalSurgical Endoscopy and Other Interventional Techniques
Volume18
Issue number4
DOIs
StatePublished - Apr 2004
Externally publishedYes

Keywords

  • Achalasia
  • Botulinum toxin
  • Cost analysis
  • Laparoscopic Heller myotomy

ASJC Scopus subject areas

  • Surgery

Fingerprint Dive into the research topics of 'Botulinum toxin injection vs laparoscopic myotomy for the treatment of esophageal achalasia: Economic analysis of a randomized trial'. Together they form a unique fingerprint.

  • Cite this

    Zaninotto, G., Vergadoro, V., Annese, V., Costantini, M., Costantino, M., Molena, D., Rizzetto, C., Epifani, M., Ruol, A., Nicoletti, L., & Ancona, E. (2004). Botulinum toxin injection vs laparoscopic myotomy for the treatment of esophageal achalasia: Economic analysis of a randomized trial. Surgical Endoscopy and Other Interventional Techniques, 18(4), 691-695. https://doi.org/10.1007/s00464-003-8910-6