Bleeding Oesophageal Varices

Stephen, Michael S.; Little, J. M.

doi:10.1111/j.1445-2197.1978.tb07295.x

Cited by 14 publications

(2 citation statements)

References 13 publications

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“…17,18 Cost-effectiveness and cost-benefit analyses have been reported either as part of clinical algorithms for the management of variceal hemorrhage or as computer-simulated decision analytic models. 3,20,22,23 Others have reported associated costs as part of prospective, randomized clinical trials comparing ES with surgery or TIPS.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 However, there are limited economic data on the medical costs of care for patients treated with alternative endoscopic hemostatic therapies for EVH. [17][18][19][20][21][22][23] None of the aforementioned reported studies prospectively comparing ES and EL included economic assessments of health care costs as part of the measured patient outcomes. [7][8][9][10][11][12][13][14] Moreover, models for accurately and reliably estimating direct costs in prospective trials of endoscopic hemostasis for variceal hemorrhage do not exist.…”

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The Economic Impact of Esophageal Variceal Hemorrhage: Cost–Effectiveness Implications of Endoscopic Therapy

et al. 1999

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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. Esophageal variceal hemorrhage (EVH) is a common cause of upper gastrointestinal (UGI) hemorrhage, accounting for approximately one third of diagnoses in individuals presenting with UGI bleeding. 1,2 Individuals with EVH require hospital admission, usually to an intensive care unit (ICU), blood product transfusions, acute and follow-up endoscopic treatment sessions in an attempt to obliterate varices, and, overall, they place a prodigious demand on resources used for health care. 3 Accordingly, the estimated direct and indirect medical costs of care for EVH are enormous. 4 In 1985, direct costs of medical care for esophageal varices were estimated to be $78.2 million. 4,5 This figure includes hospital charges, physician fees, and outpatient care. During that same year, the diagnosis of EVH accounted for approximately 62,000 total hospital days in nonfederal, short-stay hospitals in the United States and was the most expensive of all digestive diseases in terms of average daily cost of hospitalization ($1,091 per day). 4,5 Moreover, the indirect costs of esophageal varices were estimated to be $47.5 million. 4,5 Endoscopic and nonendoscopic therapies for the acute treatment of EVH as well as for the prevention of variceal rebleeding are available. 6 Nonendoscopic modalities include mechanical tamponade; pharmacologic agents such as vasopressin, terlipressin, somatostatin, octreotide, and ␤-blockers; transjugular intrahepatic portosystemic shunt (TIPS); and surgery including portosystemic shunt, esophageal transection and devascularization, and liver transplantation. 6 Until recently, endoscopic sclerotherapy (ES) was the only endoscopic therapy available for the treatment of patients with EVH. However, during the last several years, a number of prospective, randomized trials comparing ES and endoscopic ligation (EL) have reported ligation to be as efficacious and safe as sclerotherapy. 7-14 Based on lower rates of variceal rebleeding, mortality, treatment-related complications (e.g., esophageal stricture formation), and fewer endoscopic treatment sessions to achieve variceal obliteration, two recent meta-analyses concluded that EL should be considered the endoscopic treatment of choice for patients with EVH. 15,16 However, there are limited economic data on the medical costs of care for patients treated with alternative endoscopic hemostatic therapies for EVH. [17][...

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Section: Discussionmentioning

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The Economic Impact of Esophageal Variceal Hemorrhage: Cost–Effectiveness Implications of Endoscopic Therapy

et al. 1999

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Isolated Splenic Vein Thrombosis

Glynn¹

1986

Arch Surg

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A randomized trial comparing transjugular intrahepatic portosystemic stent-shunt with variceal band ligation in the prevention of rebleeding from esophageal varices

et al. 1997

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The aim of this study was to compare transjugular intrahepatic portosystemic stent-shunt (TIPSS) with variceal band ligation (VBL) in the secondary prophylaxis of esophageal variceal hemorrhage in patients with cirrhosis. Fifty-eight patients with cirrhosis who presented with the first episode of esophageal variceal hemorrhage were randomized to TIPSS (31) or VBL (27), 24 hours after control of bleeding. Shunt function was assessed after 1 month and then at 6 monthly intervals thereafter. VBL was performed weekly until variceal eradication, and then at 3 months, 6 months, and yearly thereafter. Mean follow-up in the TIPSS group was 15.7 (+/-10.2) months; in the VBL group, it was 16.8 (+/-10.9) months. Results for rebleeding and mortality were analyzed on an intention-to-treat basis and using the Kaplan-Meier method. The frequency and the severity of variceal rebleeding was significantly lower in the TIPSS group (9.8%), compared with the VBL group (51.9%) (P < .0006). Although mortality rates were not significantly different, 8 of the patients who rebled in the VBL group required TIPSS therapy for uncontrolled bleeding. No significant differences were found in the frequency of other complications such as encephalopathy and sepsis. Patients in the VBL group required significantly greater time in the intensive care unit during the period of this study (<0.03). The total direct cost of treatment incurred was pound sterling 1,373 ($2,200) per patient, the cost being less in the patients treated with TIPSS compared with VBL. The results of this study show that TIPSS is superior to VBL for the secondary prophylaxis of variceal hemorrhage in patients with cirrhosis.

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Bleeding Oesophageal Varices

Cited by 14 publications

References 13 publications

The Economic Impact of Esophageal Variceal Hemorrhage: Cost–Effectiveness Implications of Endoscopic Therapy

The Economic Impact of Esophageal Variceal Hemorrhage: Cost–Effectiveness Implications of Endoscopic Therapy

Isolated Splenic Vein Thrombosis

A randomized trial comparing transjugular intrahepatic portosystemic stent-shunt with variceal band ligation in the prevention of rebleeding from esophageal varices

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