title: The cost of achalasia: quantifying the effect of symptomatic disease on patient cost burden, treatment time, and work productivity.
abstract: 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.
authors.affiliation: University of Toronto, Toronto, ON, Canada. rnenshi@gmail.com
authors.forename: Rahima
authors.initials: R
authors.lastname: Nenshi
authors.forename: Julie
authors.initials: J
authors.lastname: Takata
authors.forename: Stacey
authors.initials: S
authors.lastname: Stegienko
authors.forename: Binu
authors.initials: B
authors.lastname: Jacob
authors.forename: Paul
authors.initials: P
authors.lastname: Kortan
authors.forename: Wayne
authors.initials: W
authors.lastname: Deitel
authors.forename: Audrey
authors.initials: A
authors.lastname: Laporte
authors.forename: Gail
authors.initials: G
authors.lastname: Darling
authors.forename: David R
authors.initials: DR
authors.lastname: Urbach
mesh_terms: 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