Cost Effectiveness of Early Insertion of Transjugular Intrahepatic Portosystemic Shunts for Recurrent Ascites

Shen, Nicole T.; Schneider, Yecheskel; Congly, Stephen E.; Rosenblatt, Russell; Namn, Yunseok; Fortune, Brett E.; Jesudian, Arun; Brown, Robert S.

doi:10.1016/j.cgh.2018.03.027

Cited by 18 publications

(13 citation statements)

References 34 publications

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“…Our economic searches did not identify any UK-based cost-utility analyses indicating this is the first UK economic evaluation of ePTFE covered stents for either indication. Our results are in line with two cost-utility analyses conducted in the USA, by Shen et al 21 and Kwan et al, 32 where TIPSS was highly cost-effective, although neither found TIPSS to be cost-saving. Differences may have occurred due to the shorter time horizon (1 year) adopted by Shen et al, 21 and the use of bare metal stents studies to inform clinical parameters by Kwan et al 32 Our results in RA are consistent with a real-world retrospective cost analysis by Parker et al of 24 TIPSS patients with RA managed at an NHS hospital.…”

Section: Consistency With Other Studiessupporting

confidence: 91%

“…Our results are in line with two cost-utility analyses conducted in the USA, by Shen et al 21 and Kwan et al, 32 where TIPSS was highly cost-effective, although neither found TIPSS to be cost-saving. Differences may have occurred due to the shorter time horizon (1 year) adopted by Shen et al, 21 and the use of bare metal stents studies to inform clinical parameters by Kwan et al 32 Our results in RA are consistent with a real-world retrospective cost analysis by Parker et al of 24 TIPSS patients with RA managed at an NHS hospital. 31 Mean savings using TIPSS as opposed to LVP with albumin were £2759 per person (2012/2013 prices) which increased to £4570 per person when removing an outlier.…”

Section: Consistency With Other Studiessupporting

confidence: 91%

“…All data were obtained from RCTs or metaanalyses excluding two observational studies which informed the technical success rate for TIPSS, equal to 98%, 19 and the rate of catheter failure for patients with LVP equal to 3.8%. 20 In addition, we followed methods by Shen et al 21 and applied a conservative assumption for the rate of recurrent bleeding for TIPSS patients in the RA indication, set equal to 4.4% as opposed to 0% in Bureau et al 11 Healthcare resource usage and unit costs TIPSS and standard care We conducted pragmatic literature searches of UK and European clinical guidelines and economic studies to identify resource use and unit costs. Resources required for the preoperative, intraoperative and postoperative phases of TIPSS were extracted from UK clinical guidelines.…”

Section: Indication 1-variceal Bleedingmentioning

confidence: 99%

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Economic evaluation of covered stents for transjugular intrahepatic portosystemic stent shunt in patients with variceal bleeding and refractory ascites secondary to cirrhosis

Mattock

Tripathi

O’Neill

et al. 2021

BMJ Open Gastroenterol

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ObjectivesTransjugular intrahepatic portosystemic stent shunt (TIPSS) is clinically effective in variceal bleeding and refractory ascites; however, the cost-effectiveness of TIPSS has yet to be evaluated in the UK. This study aimed to establish the cost-effectiveness of (i) pre-emptive TIPSS versus endoscopic band ligation (EBL) in populations with variceal bleeding and (ii) TIPSS versus large volume paracentesis (LVP) in refractory ascites.MethodsA cost-utility analysis was conducted with the perspective including healthcare costs and quality-adjusted life years (QALYs). A Markov model was constructed with a 2-year time horizon, health states for mortality and survival and probabilities for the development of variceal bleeding, ascites and hepatic encephalopathy. A survival analysis was conducted to extrapolate 12-month to 24-month mortality for the refractory ascites indication. Uncertainty was analysed in deterministic and probabilistic sensitivity analyses.ResultsTIPSS was cost-effective (dominant) and cost saving for both indications. For variceal bleeding, pre-emptive TIPSS resulted in 0.209 additional QALYs, and saved £600 per patient compared with EBL. TIPSS had a very high probability of being cost-effective (95%) but was not cost saving in scenario analyses driven by rates of variceal rebleeding. For refractory ascites, TIPSS resulted in 0.526 additional QALYs and saved £17 983 per patient and had a 100% probability of being cost-effective and cost saving when compared with LVP.ConclusionsTIPSS is a cost-effective intervention for variceal bleeding and refractory ascites. TIPSS is highly cost-saving for refractory ascites. Robust randomised trial data are required to confirm whether pre-emptive TIPSS is cost saving for variceal bleeding.

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Section: Consistency With Other Studiessupporting

confidence: 91%

Section: Consistency With Other Studiessupporting

confidence: 91%

Section: Indication 1-variceal Bleedingmentioning

confidence: 99%

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Economic evaluation of covered stents for transjugular intrahepatic portosystemic stent shunt in patients with variceal bleeding and refractory ascites secondary to cirrhosis

Mattock

Tripathi

O’Neill

et al. 2021

BMJ Open Gastroenterol

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“…Additionally, early stent placement turns out to be more cost-effective in those patients with cirrhosis and refractory ascites who need LVP more often than every 10 wk (> 5 LVPs per year) and are candidates for TIPS[106].…”

Section: Treatment Of Ascites In Patients With Cirrhosismentioning

confidence: 99%

Current approaches to the management of patients with cirrhotic ascites

Garbuzenko¹,

Arefyev²

2019

WJG

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This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 1991-2018 using the keywords: “liver cirrhosis,” “portal hypertension,” “ascites,” “pathogenesis,” “diagnostics,” and “treatment.” Uncomplicated and refractory ascites in patients with cirrhosis were the inclusion criteria. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients.

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“…Studies looking into the cost effectiveness of TIPSS in the setting of (refractory) ascites have tended to favour TIPSS. In a relatively recent study 35 the authors concluded that TIPSS placement early in the natural history of recurrent ascites has a better incremental cost-effectiveness ratio adjusted by Quality-Adjusted Life Year as compared with large-volume paracentesis (LVP) + albumin infusion.…”

Section: Cost Effectiveness Of Pre-emptive Tipss and Real-life Practimentioning

confidence: 99%

The role of pre-emptive Transjugular Intrahepatic Portosystemic Shunt in acute variceal bleeding: a literature review

Manning

Elzubeir

Alam

2021

Therapeutic Advances in Chronic Disease

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The development of portal hypertension has serious implications in the natural history of liver cirrhosis, leading to complications such as ascites, hepatic encephalopathy and variceal bleeding. The management of acute variceal bleeding has improved in the last two decades, but despite the advances in endoscopic methods the overall prognosis remains poor, particularly within a subgroup of patients with more advanced disease. The role of Transjugular Intrahepatic Portosystemic Shunt (TIPSS) is a well-established method of achieving haemostasis by immediate portal decompression; however, its use in an emergency setting as a rescue strategy is still associated with high mortality. It has been shown that ‘early’ use of TIPSS as a pre-emptive strategy in a patient with acute variceal bleed in addition to the standard of care confers superior survival outcomes in a subgroup of patients at high risk of treatment failure and death. The purpose of this review is to appraise the literature around the indications, patient selection, utility, complications and economic considerations of pre-emptive TIPSS.

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Cost Effectiveness of Early Insertion of Transjugular Intrahepatic Portosystemic Shunts for Recurrent Ascites

Cited by 18 publications

References 34 publications

Economic evaluation of covered stents for transjugular intrahepatic portosystemic stent shunt in patients with variceal bleeding and refractory ascites secondary to cirrhosis

Economic evaluation of covered stents for transjugular intrahepatic portosystemic stent shunt in patients with variceal bleeding and refractory ascites secondary to cirrhosis

Current approaches to the management of patients with cirrhotic ascites

The role of pre-emptive Transjugular Intrahepatic Portosystemic Shunt in acute variceal bleeding: a literature review

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