Prevalence and Costs of Esophageal Strictures in the United States

Background and Aims Esophageal strictures are a leading cause of dysphagia, but data regarding the epidemiology of esophageal strictures are limited. This study aimed to investigate the prevalence, healthcare utilization, and financial burden of esophageal strictures in the United States. Methods We performed a retrospective cohort study utilizing two large national insurance claims databases (MarketScan and Medicare). Using ICD-9 and -10 diagnostic codes, annual prevalence was calculated for both cohorts overall, as well as stratified by age and sex strata. Most common diagnostic and procedural codes associated with esophageal strictures were extracted and analyzed to estimate healthcare utilization. Direct annual medical costs of esophageal strictures were calculated. Results The annual prevalence of esophageal strictures in MarketScan in 2021 was 203.14 cases/100,000 people while the annual prevalence in Medicare cohort in 2017 was 1123.47 cases/100,000. While rates were relatively stable over time, esophageal stricture prevalence increased with advancing age. No prevalence differences were noticed between males and females. GERD/erosive esophagitis was the top diagnostic code associated with esophageal strictures, though an increase in the proportion of eosinophilic esophagitis codes was noted over time. Esophageal dilation codes were present in ∼50% of stricture cases. The total healthcare costs associated with esophageal strictures were estimated at $1.39 billion in 2017. Conclusions Esophageal strictures are common, affecting between 1/100 to 1/1000 patients in the United States, with the highest rates seen in patients aged 75y and older. Accordingly, strictures have a significant financial burden on the healthcare system, with costs above $1 billion annually.