J Neurogastroenterol Motil  
Early Assessment of Cost-effectiveness of Gastric Electrical Stimulation for Diabetic Nausea and Vomiting
Mette W Klinge,1,2* Peter Rask,2 Lene S Mortensen,3 Kathrine Lassen,4 Niels Ejskjaer,1 Lars H Ehlers,4 and Klaus Krogh1
Departments of 1Hepatology and Gastroenterology, 2Abdominal Surgery, and 3Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; and 4Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark
Correspondence to: Mette W Klinge, MD
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Noerrebrogade 44, building 1C, 1st floor, 8000 Aarhus C, Denmark
Tel: +45-78462800, E-mail: meteader@rm.dk
Received: October 15, 2016; Revised: January 4, 2017; Accepted: February 27, 2017; Published online: May 4, 2017.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims
Recurrent nausea and/or vomiting are common complications of diabetes mellitus. The conditions severely impact the quality of life of patients and often cause repeated admissions to hospital incurring significant healthcare costs. If standard treatment fails, gastric electrical stimulation (GES) may be offered in selected cases, as a minimally invasive, but expensive, therapeutic option. Our aims are to evaluate the clinical effect and the cost-utility of GES as a treatment for severe diabetic recurrent nausea and/or vomiting.
Methods
Among 33 diabetes patients implanted with GES because of recurrent nausea and/or vomiting, 30 were available for evaluation. The effect of treatment was assessed prospectively using symptom-diaries and the SF-36 questionnaires at baseline, after 6 and 12 months, and thereafter yearly. The number of days in hospital due to symptoms related to gastrointestinal dysfunction was calculated using hospital records 12 months prior to and 12 months after implantation.
Results
The surgical procedures were performed without mortality or major complications. Six months after surgery 78% of the respondents had at least 50% reduction in time with nausea and 48% had at least 50% reduction in days with vomiting. Symptom relief persisted at follow-up after at least 4 years. Quality adjusted life years improved after GES, which was cost-effective after 24 months.
Conclusions
GES reduces symptoms and improves quality of life in diabetes patients with recurrent nausea and/or vomiting. The procedure is supposed as cost-effective over a 2-year time horizon.
Keywords: Diabetes mellitus; Electrical stimulation; Health care costs; Nausea; Vomiting


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