+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Costs and clinical outcomes of primary prophylaxis of variceal bleeding in patients with hepatic cirrhosis: A decision analytic model



Costs and clinical outcomes of primary prophylaxis of variceal bleeding in patients with hepatic cirrhosis: A decision analytic model



American Journal of Gastroenterology 98(4): 763-770



OBJECTIVE: Current guidelines recommend upper endoscopic screening for patients with hepatic cirrhosis and primary prophylaxis with a nonselective beta-blocker for those with large varices. However, only 25% of cirrhotics develop large varices. Thus, the aim of this study is to evaluate the most cost-effective approach for primary prophylaxis of variceal hemorrhage. METHODS: Using a Markov model, we compared the costs and clinical outcomes of three strategies for primary prophylaxis of variceal bleeding. In the first strategy, patients were given a beta-blocker without undergoing upper endoscopy. In the second strategy, patients underwent upper endoscopic screening; those found to have large varices were treated with a beta-blocker. In the third strategy, no prophylaxis was used. Selected sensitivity analyses were performed to validate outcomes. RESULTS: Our results show screening prophylaxis was associated with a cost of dollar sign37,300 and 5.72 quality-adjusted life yr (QALYs). Universal prophylaxis was associated with a cost of dollar sign34,100 and 6.65 QALYs. The no prophylaxis strategy was associated with a cost of dollar sign36,600 and 4.84 QALYs. The incremental cost-effectiveness ratio was dollar sign800/QALY for the endoscopic strategy relative to the no prophylaxis strategy. Screening endoscopy was cost saving when the compliance, bleed risk without beta-blocker, and variceal bleed costs were increased, and when the discount rate, bleed risk on beta-blockers, and cost of upper endoscopy were decreased. In contrast, the universal prophylaxis strategy was persistently cost saving relative to the no prophylaxis strategy. In comparing the strategies, sensitivity analysis on the death rates from variceal hemorrhage did not alter outcomes. CONCLUSIONS: Our results provide economic and clinical support for primary prophylaxis of esophageal variceal bleeding in patients with hepatic cirrhosis. Universal prophylaxis with beta-blocker is preferred because it is consistently associated with the lowest costs and highest QALYs.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 010393531

Download citation: RISBibTeXText

PMID: 12738453

DOI: 10.1016/s0002-9270(03)00056-x


Related references

Costs and clinical outcomes of multi-vessel coronary stenting compared with bypass surgery A single-center experience. Circulation 102(18 Suppl.): II 731, 2000

Decision analysis utilizing data from multiple life-cycle impact assessment methods Part II Model development. Journal Of Industrial Ecology. 8(1-2): 119-141, Winter, 2004

Hemodynamic response to behavioral stress in obese vs lean Zucker rats. FASEB Journal 13(4 Part 1): A453, 1999

Comparison of Clinical Outcomes Between Ticagrelor and Prasugrel in Patients With ST-Segment Elevation Myocardial Infarction - Results From the Korea Acute Myocardial Infarction Registry-National Institutes of Health. Circulation Journal 82(7): 1866-1873, 2018

PTU-092Plasma Angiopoietin 2, A Circulating Marker of Endothelial Cell Activation, Is Elevated in Acute Alcoholic Hepatitis. Gut 65(Suppl 1): A100.1-A100, 2016

Variations, during aging, of the content of nucleotides and free pentoses in the muscular and cerebral tissues of rats. Giornale di Gerontologia 10: 341-344, 1962

Assessment of bismuth thiols and conventional disinfectants on drinking water biofilms. Journal of Applied Microbiology 95(2): 288-293, 2003

A cost-effectiveness analysis of chemotherapy for patients with recurrent platinum-sensitive epithelial ovarian cancer. Gynecologic Oncology 105(1): 223-227, 2000

Long-term results of Total Therapy studies 11, 12 and 13A for childhood acute lymphoblastic leukemia at St Jude Childrens Research Hospital. Leukemia (basingstoke). 14(12): 2286-2294, Ember, 2000

Variceal bleeding in patients with cirrhosis: what are the unanswered questions?. Gastroenterologie Clinique et Biologique 32(6-7): 614-619, 2008

Primary prophylaxis for Pneumocystis carinii pneumonia: a randomized trial comparing cotrimoxazole, aerosolized pentamidine and dapsone plus pyrimethamine. Aids 7(1): 59-64, 1993

Endoscopic variceal ligation plus propranolol versus endoscopic variceal ligation alone in primary prophylaxis of variceal bleeding. American Journal of Gastroenterology 100(4): 797-804, 2005

The hemodynamic inverse problem: making inferences about neural activity from measured MRI signals. Proceedings of the National Academy of Sciences of the United States of America 100(5): 2177-2179, 2003

Acute and chronic heart failure--innovations of the last year and their underlying clinical trials. Deutsche Medizinische Wochenschrift 139(45): 2294-2298, 2014

Primary prophylaxis of spontaneous bacterial peritonitis. Gastroenterologia Y Hepatologia 20(6): 312-314, 1997