Epidemiologic and Economic Burden of Achalasia in the United States.

ABSTRACT Background & Aims Achalasia is a debilitating chronic condition of the esophagus. Currently there are no national estimates on the epidemiologic and economic burden of disease. We sought to estimate trends in incidence and prevalence of achalasia by age-sex strata, and to estimate the total direct medical costs attributed to achalasia in the United States (U.S.). Methods We conducted a cohort study using two administrative claims databases: IBM MarketScan Commercial Claims and Encounters database (2001-2018; age Results The crude prevalence of achalasia per 100,000 persons was 18.0 (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 person-years was 10.5 (95% CI: 9.9, 11.1) in MarketScan and 26.0 (95% CI: 24.9, 27.2) in Medicare. Incidence and prevalence increased substantially over time in the Medicare cohort, and increased with more advanced age in both cohorts. Utilization of achalasia-specific healthcare was high; national estimates of total direct medical costs exceeded $408 million in 2018. Conclusions Achalasia has a higher epidemiologic and economic burden in the U.S. than previously suggested, with diagnosis particularly increasing in older patients.