A cost-utility analysis of secondary prophylaxis for variceal hemorrhage

The American Journal of Gastroenterology
Joel H RubensteinJohn M Inadomi

Abstract

Secondary prophylaxis for esophageal variceal hemorrhage (VH) is recommended, but there has never been a cost-utility analysis of its implementation. The objective was to compare the cost utility of various strategies for the secondary prophylaxis of VH including (a) observation alone, (b) medical therapy (MED), (c) endoscopic band ligation (EBL), (d) endoscopic band ligation plus medical therapy (EBL + M), and (e) transjugular intrahepatic portosystemic shunt (TIPS), and to examine the effect of adherence on these strategies. A Markov model was developed for all five strategies, and included surveillance, risk of hepatic encephalopathy, complications, and nonadherence. Published literature and the Health Care Financing Administration. People with cirrhosis and a history of controlled VH. Three years. Third-party payer. Incremental cost-effectiveness ratios for quality-adjusted life-years (QALYs) gained. Combination EBL + M was the optimal strategy, dominating all other strategies including observation, meaning that it was more effective and less expensive than the others. In addition, EBL alone dominated observation and TIPS in terms of QALYs, and MED alone dominated the strategy of observation in terms of QALYs. Important var...Continue Reading

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Citations

Nov 3, 2005·Nature Clinical Practice. Gastroenterology & Hepatology·Patrick S Kamath, Vijay Shah
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