Achalasia is a disorder characterized by abnormal motility of the esophageal 
body and the lower esophageal sphincter, resulting in dysphagia, regurgitation, 
and chest pain. Treatment options for achalasia include Botulinum toxin 
injection, pneumatic balloon dilation, and surgical esophagomyotomy. The aim of 
this study was to determine the cost-effectiveness of these three strategies in 
the treatment of achalasia in adults. We constructed a Markov cost-effectiveness 
model comparing Botox injection, pneumatic balloon dilation, and laparoscopic 
esophagomyotomy as initial treatments of achalasia. Costs and probabilities were 
derived from the published literature. The utility for symptomatic achalasia was 
derived from a sample of patients with achalasia. Sensitivity analyses were 
performed. Over a five-year time horizon, pneumatic dilation was the most 
cost-effective treatment strategy for achalasia, with an incremental 
cost-effectiveness ratio of $1348 per quality-adjusted life-year compared to 
Botox. Although laparoscopic esophagomyotomy was more effective than the other 
treatment options, it was not cost-effective because of its high initial cost. 
In conclusion, pneumatic dilation is the most cost-effective treatment option 
for adults with achalasia. Further studies should examine the long-term relapse 
rates following treatment with Botox and more precisely determine the quality of 
life of symptomatic achalasia.