LAUSR

BACKGROUND AND AIMS Reimbursement often presents a significant barrier to widespread adoption of innovative endoscopic devices. We aimed to determine the value (defined as cost savings to a payer) of endoscopic suturing devices in preventing the migration of esophageal stents placed for benign esophageal diseases. METHODS A decision analytic model was constructed from a payer perspective evaluating fully covered metal stent (FC-SEMS) placement for benign esophageal diseases (fistula, leak, perforation, or stricture) in a hospital outpatient setting. The model compared 2 strategies: endoscopic suturing to anchor the stent or no suture. Healthcare outcomes and costs were derived from published systematic reviews and national databases (FDA MAUDE for safety data, 2018 Medicare Physician Fee Schedule and Provider Utilization and Payment Data databases for reimbursement data). RESULTS From a payer perspective, reimbursement for care increased by $1,487.98 without endoscopic suturing per patient, compared with $621.06 with endoscopic suturing, to cover the risk of stent migration in addition to usual professional and facility reimbursement for stent placement. Thus, an average cost-savings of $866.92 per patient was achieved with endoscopic suturing to reduce stent migration risks. Cost-savings associated with suturing ranged from $147.48 to $1,586.36 per patient, based on the indication for procedure in sensitivity analysis. Cost-savings increased with higher rates of technical success in suture placement. CONCLUSIONS Creating a defined reimbursement pathway for endoscopic suture fixation of a stent for the treatment of benign esophageal diseases appears to be justified from a payer perspective.