Achalasia burden higher than previously suggested
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The epidemiologic and economic burden of esophageal achalasia appears higher than previously reported, according to study results.
Evan S. Dellon, MD, MPH, from the University of North Carolina School of Medicine, and colleagues wrote that previous estimates of incidence and prevalence of achalasia in the United States were between 2 and 5 and between 11 and 32 per 100,000 people, respectively.
“However, these estimates have limitations,” they wrote. “They come from older data, describe populations outside the U.S. or narrowly defined within the U.S, and do not provide age-sex-stratum specific measures of incidence and prevalence. There are no existing estimates on utilization of health care or treatment, nor national cost figure.”
Researchers conducted a cohort study to estimate the trends in incidence and prevalence of achalasia using two administrative claims databases, the IBM MarketScan Commercial Claims and Encounters database (age younger than 65 years) and a 20% sample of nationwide Medicare enrollment and claims (age at least 65 years). They also explored the use rates of health care services and procedures, as well as the mean costs per patient.
Dellon and colleagues found that the crude prevalence of achalasia per 100,000 persons was 18 (95% CI, 17.4-18.7) in MarketScan and 162.1 (95% CI, 157.6-166.6) in Medicare. The crude incidence rate per 100,000 people was 10.5 (95% CI, 9.9-11.1) in MarketScan and 26 (95% CI, 24.9-27.2) in Medicare.
In the Medicare cohort, both incidence and prevalence increased over time, while they increased with more advanced age in both cohorts.
Achalasia-specific health care use was high, with a national estimate of more than $408 million in total direct medical costs in 2018.
“Our finding that incidence and prevalence increases with age calls into question whether older adults are more susceptible to this debilitating disease or what past exposures may contribute to this increased risk in later stages in the life course,” Dellon and colleagues wrote. “The economic burden of disease was substantial, and coupled with the epidemiologic estimates, suggest that achalasia warrants increased research investment across the spectrum from etiologic research to comparative effectiveness assessments of existing and emerging treatments.”
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