Is Gastric Electric Stimulation Cost-Effective in Patients With Refractory Vomiting?

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.