Achalasia is a disorder characterized by abnormal motility of the esophageal body and the lower esophageal sphincter, resulting in
dysphagia, regurgitation, and
chest pain. Treatment options for
achalasia include
Botulinum toxin injection, pneumatic balloon dilation, and surgical esophagomyotomy. The aim of this study was to determine the cost-effectiveness of these three strategies in the treatment of
achalasia in adults. We constructed a Markov cost-effectiveness model comparing
Botox injection, pneumatic balloon dilation, and laparoscopic esophagomyotomy as initial treatments of
achalasia. Costs and probabilities were derived from the published literature. The utility for symptomatic
achalasia was derived from a sample of patients with
achalasia. Sensitivity analyses were performed. Over a five-year time horizon, pneumatic dilation was the most cost-effective treatment strategy for
achalasia, with an incremental cost-effectiveness ratio of $1348 per quality-adjusted life-year compared to
Botox. Although laparoscopic esophagomyotomy was more effective than the other treatment options, it was not cost-effective because of its high initial cost. In conclusion, pneumatic dilation is the most cost-effective treatment option for adults with
achalasia. Further studies should examine the long-term relapse rates following treatment with
Botox and more precisely determine the quality of life of symptomatic
achalasia.