Table 3.
Temporal trends in healthcare utilization rates of period-prevalent patients per 1000 enrolled person-years, by study year in Medicare
| Period prevalent patients, N |
2008
4,728 |
2009
4,776 |
2010
4,883 |
2011
5,318 |
2012
5,388 |
2013
5,635 |
2014
6,604 |
2015
6,958 |
APC (95% CI) |
|---|---|---|---|---|---|---|---|---|---|
| Healthcare services* per 1000 enrollee years | |||||||||
| Hospitalizations | 75.2 | 85.3 | 79.6 | 88.2 | 75.9 | 74.9 | 76.2 | 86.4 | 0.2 (−1.4, 1.8) |
| Emergency room visits | 17.3 | 12.4 | 10.8 | 12.7 | 11.8 | 14.2 | 13.5 | 18.6 | 2.8 (−1.1, 6.8) |
| Outpatient visits | 468.6 | 502.1 | 500.3 | 523.7 | 553.9 | 578.5 | 613.1 | 628.6 | 4.4 (3.7, 5.0) |
| Diagnostic procedures per 1000 enrollee years | |||||||||
| Thorax CT or X-ray | 785.2 | 867.8 | 781.4 | 809.9 | 819.9 | 844.3 | 838.1 | 849.1 | 0.7 (0.2, 1.3) |
| Barium swallow | 279.9 | 311.6 | 299.6 | 289.5 | 293.2 | 303.1 | 294.4 | 309.5 | 0.6 (−0.3, 1.4) |
| Esophagoscopy & UE | 847.9 | 907.6 | 840.4 | 870.4 | 833.5 | 872.0 | 849.2 | 835.9 | −0.5 (−0.9, 0.0) |
| Manometry | 90.9 | 92.4 | 90.4 | 99.7 | 98.1 | 113.3 | 122.0 | 132.5 | 6.1 (4.7, 7.6) |
| Reflux monitoring | 18.6 | 20.5 | 23.1 | 25.4 | 37.2 | 48.8 | 54.6 | 59.9 | 20.6 (17.6, 23.7) |
| Therapeutic procedures per 1000 enrollee years | |||||||||
| Pneumatic dilation | 13.6 | 12.6 | 8.0 | 10.3 | 9.5 | 10.9 | 12.7 | 10.4 | −1.1 (−5.3, 3.2) |
| Surgical myotomy | 9.6 | 21.1 | 20.5 | 17.2 | 19.3 | 22.6 | 23.3 | 23.4 | 7.2 (3.7, 10.7) |
| Anti-reflux surgery | 15.7 | 29.7 | 27.0 | 32.9 | 32.2 | 38.1 | 35.0 | 39.4 | 8.7 (5.9, 11.5) |
| Esophagectomy | 1.9 | 3.2 | 2.1 | 2.4 | 1.8 | 2.2 | 1.7 | 1.4 | −6.1 (−15.0, 3.7) |
| Unlisted procedure of esophagus† | 3.7 | 2.9 | 2.8 | 4.2 | 6.8 | 5.5 | 5.3 | 11.3 | 19.7 (12.1, 27.8) |
| Dispensed medications, prescriptions per 1000 enrollee years | |||||||||
| CCBs | 900.8 | 867.8 | 948.2 | 1,081.8 | 1,133.3 | 1,191.3 | 1,123.3 | 1,144.6 | 4.1 (3.7, 4.6) |
| PPIs | 1,114.8 | 1,630.1 | 1,280.9 | 1,476.9 | 1,877.3 | 2,311.2 | 2,285.3 | 2,418.6 | 11.1 (10.8, 11.5) |
| Nitrates | 634.5 | 422.3 | 407.1 | 295.8 | 244.4 | 308.2 | 311.5 | 346.5 | −8.2 (−8.8, −7.5) |
| Anticholinergics | 115.6 | 74.7 | 31.6 | 4.7 | 1.1 | 6.9 | 9.5 | 5.9 | −43.5 (−45.7, −41.3) |
| Antidepressants & neuromodulators | 1,251.6 | 1,394.4 | 1,427.7 | 1,642.0 | 1,795.1 | 1,894.1 | 2,257.5 | 2,484.1 | 10.5 (10.1, 10.9) |
| Opioid medications | 582.4 | 582.6 | 701.0 | 849.9 | 905.7 | 1,057.8 | 1,222.1 | 1,313.0 | 13.5 (12.9, 14.0) |
| Pro-motility drugs | 302.7 | 180.3 | 115.3 | 134.0 | 76.3 | 104.4 | 87.1 | 45.6 | −19.9 (−21.0, −18.9) |
Abbreviations: GI, gastrointestinal; EKG, electrocardiogram; UE, upper endoscopy; CCBs, calcium channel blockers; PPIs, proton pump inhibitors
*
Hospitalizations, emergency department visits, and office visits all required a diagnosis of achalasia in the first or second diagnosis position Period prevalent includes patient with prevalent disease on January 1st of a given year and incident cases that develop achalasia in that calendar year.
†
Peroral endoscopic myotomy (POEM) does not have a specified CPT code, currently billed as unlisted procedure of the esophagus