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Cost‐effectiveness analysis of variceal ligation vs. beta‐blockers for primary prevention of variceal bleeding
Author(s) -
Imperiale Thomas F.,
Klein Robert W.,
Chalasani Naga
Publication year - 2007
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.21605
Subject(s) - medicine , ligation , beta (programming language) , gastroenterology , computer science , programming language
Abstract Although both β‐blockade (BB) and endoscopic variceal ligation (EVL) are used for primary prevention of variceal bleeding (VB) in patients with cirrhosis with moderate to large esophageal varices (EVs), the more cost‐effective option is uncertain. We created a Markov decision model to compare BB and EVL in such patients, examining both cost‐effectiveness (cost per life year [LY]) and cost‐utility (cost per quality‐adjusted life year [QALY]). Outcomes included cost per LY, cost per QALY, proportions of persons with VB, TIPS, and all‐cause mortality. EVL and BB were compared using the incremental cost‐effectiveness ratio (ICER) and incremental cost‐utility ratio (ICUR). When considering only LYs, initial EVL exceeds the benchmark of $50,000/LY, with an ICER of $98,407. However, when quality of life (QoL) is considered, EVL is cost‐effective compared to BB (ICUR of $25,548/QALY). In sensitivity analysis, EVL is cost‐effective if the yearly risk of EV bleeding is ≥ 0.26 (base case 0.15), the relative risk of bleeding on BB is ≥ 0.69 (base case 0.58), or if the relative risk of bleeding with EVL is < 0.27 (base case 0.35). The ICUR favored EVL unless the relative risk of bleeding on BB is < 0.46, the relative risk of bleeding with EVL is > 0.46, or the time horizon is ≤ 24 months. Whether EVL is “cost‐effective” relative to BB therapy for primary prevention of EV bleeding depends on whether LYs or QALYs are considered. If only LYs are considered, then EVL is not cost‐effective compared to BB therapy; however, if QoL is considered, then EVL is cost‐effective. (H EPATOLOGY 2007;45:870–878.)