Endocrine Abstracts (2007) 13 P72

A cost benefit analysis of gastric electrical stimulation (GES) in patients with severe diabetic gastoparesis

Mark Hannon1, Obada Yousif2, Sean Dineen3, Christopher J Thompson4, Eamonn MM Quigley1 & Domhnaill J O’Halloran1

1Cork University Hospital, Cork, Ireland; 2Wexford General Hospital, Wexford, Ireland; 3University College Hospital Galway, Galway, Ireland; 4Beaumont Hospital, Dublin, Ireland.

Introduction: Patients who are severely affected with diabetic gastroparesis tend to spend many days as hospital inpatients with intractable nausea and vomiting and consequent dehydration. In patients who do not respond to promotility agents, gastric electrical stimulation (GES) is an option. This is a relatively new therapeutic modality which has shown promise in international trials. It has seen use in a very limited number of patients in Ireland. Here we outline our experiences with four of these patients.

Methods: The records of all four patients with gastric pacemakers inserted were reviewed. The number of inpatient days before and after the pacemaker insertion was calculated. From these figures, a cost benefit analysis was performed to see if the commencement of GES led to a reduction in the costs incurred due to inpatient admission for gastroparesis.

Results: The total bed cost of inpatient admissions for these patients was not significantly affected by GES. The full results are shown in the table below.

PatientDuration of follow up post GESCost** of adm days in yr pre GESCost** of adm days post GESCost** per year of adm post GES (estim)Average HbA1C pre GES***Average HbA1C post GES***
19 months&z.euro;5,622&z.euro;3,748&z.euro;4,994N/A11.9%
29 months&z.euro;29,047&z.euro;84,330&z.euro;112,44010.1%10.08%
329 months&z.euro;112,440&z.euro;196,770&z.euro;81,4256.56%6.35%
4*7 months&z.euro;159,290&z.euro;85,267&z.euro;123,6847.33%7.35%
*Patient 4 deceased ∼7/12 post commencement of GES.
**Costs calculated using HSE estimates for 2004 for bed day costs in CUH.
 ***Average HbA1C calculated over 1 year pre GES and over duration of follow up post GES.

Conclusion: Diabetic gastroparesis is a serious condition which places a large burden on the Irish healthcare system. However, the benefits of GES to admissions costs and HbA1C are as yet unproven in Ireland.

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