Cost of preventing variceal rebleeding with transjugular intrahepatic portal systemic shunt and distal splenorenal shunt

JOURNAL OF HEPATOLOGY

卷:48

Article

Boyer, Thomas D.¹  Henderson, J. Michael²  Heerey, Adrienne M.³  Arrigain, Susana⁴  Konig, Vicky⁴  Connor, Jason^9,10  Abu-Elmagd, Kareem⁵  Galloway, John⁶  Rikkers, Layton F.⁷  Jeffers, Lennox⁸ 

[1] Univ Arizona, Dept Med, Liver Res Inst, Tucson, AZ 85724 USA

[2] Cleveland Clin, Dept Surg, Cleveland, OH 44106 USA

[3] Natl Univ Ireland Univ Coll Galway, Dept Med, Galway, Ireland

[4] Cleveland Clin, Cleveland, OH 44106 USA

[5] Univ Pittsburgh, Dept Surg, Pittsburgh, PA USA

[6] Emory Univ, Dept Surg, Atlanta, GA 30322 USA

[7] Univ Wisconsin, Dept Surg, Madison, WA USA

[8] Univ Miami, Dept Med, Miami, FL 33152 USA

[9] Carnegie Mellon Univ, Dept Stat, Pittsburgh, PA 15213 USA

[10] Carnegie Mellon Univ, H John Heinz Sch Publ Policy 3, Pittsburgh, PA 15213 USA

关键词: cost effectiveness;    shunts;    TIPS;    bleeding varices;   

DOI  :  10.1016/j.jhep.2007.08.014

来源: Elsevier

【 摘 要 】

Background/Aims:We examined the cost and cost effectiveness of distal splenorenal shunt (DSRS) and transjugular intrahepatic portosystemic shunt (TIPS) in the prevention of variceal rebleeding. Methods: Patients participated in a randomized controlled trial comparing DSRS to TIPS. Quality of life (QOL) was measured using SF-36 preceding randomization and yearly thereafter. Cost utility analysis was performed using TreeAge DATA(R). Costs for both in- and out-patient events and interventions were obtained for each patient. Costs using coated stents were estimated using different rates of stenosis. Incremental cost effectiveness ratios (ICERs) were determined at 1, 3 and 5 years. Results:The average yearly costs of managing patients after TIPS and DSRS over 5 years were similar, $16,363 and $13,492, respectively. Cost of TIPS for surviving patients exceeded the cost of DSRS at years 3 and 5 but not significantly. ICERs per life saved favored TIPS at year 5 ($61,000). If coated rather than bare stents were used the cost effectiveness of TIPS increased slightly. Conclusions: TIPS is as effective as DSRS in preventing variceal rebleeding and may be more cost effective. TIPS, in all aspects, is equal to DSRS in the prevention of variceal rebleeding in patients who are medical failures. (C) 2007 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

Free