Economic

Different approaches acceptable for preventing variceal bleeding

Last Updated: 2007-04-17 17:30:36 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Depending on the criteria employed, both endoscopic variceal ligation and beta-blockade could be considered cost-effective for primary prevention of variceal bleeding in patients with cirrhosis with moderate to large esophageal varices.

"The results of our analysis suggest that either beta-blocker therapy or endoscopic variceal ligation is a reasonable way to prevent a first bleeding episode from esophageal varices," lead researcher Dr. Thomas F. Imperiale told Reuters Health.

Dr. Imperiale of Indiana University School of Medicine, Indianapolis, and colleagues developed a model to examine both the incremental cost-effectiveness ratio (cost per life year) and incremental cost-utility ratio (cost per quality-adjusted life year or QALY) of ligation compared to beta-blockade. They report the results in the April issue of Hepatology,

With ligation, the incremental cost of $98,407 per life year saved was well beyond the usual acceptable benchmark figure of $50,000 per year of life saved. However, when quality of life was considered, the incremental cost dropped to $25,548/QALY.

Among the factors influencing this outcome were a calculated 3.19 bleeding-free life years with ligation, 3.04 bleeding-free life years with beta-blockers and 2.04 bleeding-free life years with observation.

Thus, concluded Dr. Imperiale, "The choice of therapy depends on patient and physician preference, and requires a discussion of the tradeoffs -- that is, the risks, benefits, et cetera -- between the two therapies."

Hepatology 2007;45:870-878.