The cost of achalasia: quantifying the effect of symptomatic disease on patient cost burden, treatment time, and work productivity.
BACKGROUND
Although the incidence of achalasia is low, the burden of suffering is high because it is a chronic incurable disease that predominantly affects young persons. This article aims to describe the impact of achalasia on health-related quality of life, patient cost burden, time dedicated to treatment, and work productivity.


METHODS
Consecutive patients enrolled in a clinical trial comparing laparoscopic myotomy with pneumatic dilatation from 4 sites across Canada (whose clinical and manometric diagnosis was confirmed) were studied using standardized patient-reported outcomes instruments, including the Achalasia Severity Questionnaire (ASQ), the Medical Outcomes Study 36-item Short Form Questionnaire (SF-36), and the Gastrointestinal Disease-Specific Quality of Life (GIQLI) questionnaire. The authors also measured health care utilization.


RESULTS
Questionnaires were completed by 54 patients (median age = 53.5 years; range = 25-78 years; 50.0% male). Patients had been experiencing symptoms for a mean of 4.5 years (standard deviation = 6.1), and 42.6% were on medication for symptom relief. Among them, 74.1% reported that their disease limited their lifestyle. Patients spent an average of CAD$30.70 a month on medication; 37.0% reported that their disease interfered with their work, and patients missed an average of 10.2 days per 6 months. Patients also spent an average of CAD$24.30 on transportation to and from each clinical appointment.


CONCLUSIONS
Achalasia substantially limits the lifestyle of patients with the disease. It also implies a financial burden of care for patients and leads to decreased work productivity.
Nenshi
Rahima
R
University of Toronto, Toronto, ON, Canada. rnenshi@gmail.com
Takata
Julie
J
Stegienko
Stacey
S
Jacob
Binu
B
Kortan
Paul
P
Deitel
Wayne
W
Laporte
Audrey
A
Darling
Gail
G
Urbach
David R
DR
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017281:Cost of Illness; D004526:Efficiency; D004931:Esophageal Achalasia / Q000150:complications* / Q000523:psychology / Q000628:therapy; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome