The cost-effectiveness of hepatic venous pressure gradient monitoring in the prevention of recurrent variceal hemorrhage

The American Journal of Gastroenterology
Laura TargownikIan M Gralnek

Abstract

Recurrent variceal hemorrhage is common following an initial bleed in patients with cirrhosis. The current standard of care for secondary prophylaxis is endoscopic band ligation (EBL). Combination of beta-blocker and nitrate therapy, guided by hepatic venous pressure gradient (HVPG) monitoring, is a novel alternative strategy. We sought to determine the cost-effectiveness of these competing strategies. Decision analysis with Markov modeling was used to calculate the cost-effectiveness of three competing strategies: (1) EBL; (2) beta-blocker and nitrate therapy without HVPG monitoring (HVPG-); and (3) beta-blocker and nitrate therapy with HVPG monitoring (HVPG+). Patients in the HVPG+ strategy who failed to achieve an HVPG decline from medical therapy were offered EBL. Cost estimates were from a third-party payer perspective. The main outcome measure was the cost per recurrent variceal hemorrhage prevented. Under base-case conditions, the HVPG+ strategy was the most effective yet most expensive approach, followed by EBL and HVPG-. Compared to the EBL strategy, the HVPG+ strategy cost an incremental 5,974 dollars per recurrent bleed prevented. In a population with 100% compliance with all therapies, the incremental cost of HVPG-v...Continue Reading

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Citations

Nov 25, 2005·The New England Journal of Medicine·Sandeep Mukherjee, Michael F Sorrell
Nov 1, 2008·Digestive Diseases and Sciences·Sameer Parikh
Mar 19, 2008·Best Practice & Research. Clinical Gastroenterology·F H Klebl, J Schölmerich
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Jul 17, 2008·Alimentary Pharmacology & Therapeutics·C K TriantosA K Burroughs
Mar 19, 2014·Liver International : Official Journal of the International Association for the Study of the Liver·Stefania CasuJaume Bosch
Apr 24, 2014·Clinical and Molecular Hepatology·Ki Tae Suk
Apr 8, 2015·World Journal of Hepatology·Ki Tae Suk, Dong Joon Kim
Aug 30, 2016·Liver International : Official Journal of the International Association for the Study of the Liver·Christian JansenJonel Trebicka
Apr 9, 2005·Current Opinion in Gastroenterology·Guadalupe Garcia-Tsao
Dec 11, 2014·World Journal of Gastroenterology : WJG·Horia Stefanescu, Bogdan Procopet
Sep 3, 2019·Ultraschall in der Medizin : Organ der Deutschen Gesellschaft für Ultraschall in der Medizin, [der] Österreichischen Gesellschaft für Ultraschall in der Medizin, [der] Schweizerischen Gesellschaft für Ultraschall in Medizin und Biologie·Horia StefanescuBogdan Procopet

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