Is Gastric Electric Stimulation Cost-Effective in Patients With Refractory Vomiting?
Vanessa M. Shami, MD, FASGE, reviewing Gourcerol G, et al. Clin Gastroenterol Hepatol 2020 Nov 12.
Medication-refractory nausea and vomiting, which is often due to gastric dysmotility, is a challenging problem. High-frequency gastric electrical stimulation (GES), which was approved by the U.S. Food and Drug Administration in 2000, can offer a viable palliative option for these patients. This multicenter study prospectively collected data from patients who underwent GES implantation for refractory nausea and/or vomiting to assess the efficacy, safety, and medico-economic impact of this treatment.
The investigators collected clinical data from 142 patients (60 with diabetes, 82 without diabetes) and medico-economic data for 96 patients (36 with diabetes, 60 without diabetes) 2 years after GES placement. The Gastrointestinal Quality of Life Index score, a questionnaire that addresses nausea and dyspeptic symptoms as well as quality of life, increased by 12.1 ± 25.0 points (P<.001), with a more significant improvement in patients without diabetes than those with diabetes (15.8 ± 25.0 points [P<.001] vs 7.3 ± 24.5 points [P=.027], respectively). Overall vomiting significantly improved, with a 25.5% (P<.001) increase in the proportion of patients vomiting less than once per month. Costs incurred included hospitalizations, time off work, and transport. GES decreased mean overall health care costs from $8873 to $5525 per patient per year (P=.001), representing an annual savings of $3348 per patient. Savings were greater for patients with diabetes ($4096 per patient annually) than for patients without diabetes ($2900 per patient annually). Although 25.4% of the patients had at least 1 device-related adverse event, no patients had major complications that required device removal.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Gourcerol G, Coffin B, Bonaz B, et al; ENTERRA Research Group. Impact of gastric electrical stimulation on economic burden of refractory vomiting: a French nationwide multicentre study. Clin Gastroenterol Hepatol 2020 Nov 12. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.11.011)