The economic impact of esophageal variceal hemorrhage: Cost-effectiveness implications of endoscopic therapy

✍ Scribed by Ian M. Gralnek; Dennis M. Jensen; Thomas O. Kovacs; Rome Jutabha; Gustavo A. Machicado; Jeffrey Gornbein; Joy King; Susie Cheng; Mary Ellen Jensen

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 75 KB
• Volume: 29
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510290141

✦ Synopsis

Esophageal variceal hemorrhage (EVH) is a serious and expensive sequela of chronic liver disease, leading to increased utilization of resources. Today, endoscopic sclerotherapy (ES) and endoscopic ligation (EL) are the accepted, community standards of endoscopic treatment of patients with EVH. However, there are no published studies comparing the economic costs of treating EVH using these interventions. As part of a prospective, randomized trial comparing ES and EL for the treatment of EVH, we estimated the direct costs of health care utilization and cost-effectiveness for the prevention of variceal rebleeding and patient survival at 1-year follow-up. Treatment groups were similar in incidence of variceal rebleeding (41.9% vs. 42.9%), variceal obliteration (41.9% vs. 40.0%), hospital days, blood transfusions, shunt requirements, and survival (71.0% vs. 60.0%). There were significantly more treatment failures for active bleeding using EL (42% vs. 0%; P ‫؍‬ .027) and esophageal stricture formation in the ES-treated patients (19.4% vs. 2.9%; P ‫؍‬ 0.03). Median total direct cost outcomes were similar between groups