Cost-effectiveness analysis of variceal ligation vs. beta-blockers for primary prevention of variceal bleeding.

Abstract

Although both beta-blockade (BB) and endoscopic variceal ligation (EVL) are used for primary prevention of variceal bleeding (VB) in patients with cirrhosis with moderate to large esophageal varices (EVs), the more cost-effective option is uncertain. We created a Markov decision model to compare BB and EVL in such patients, examining both cost-effectiveness (cost per life year [LY]) and cost-utility (cost per quality-adjusted life year [QALY]). Outcomes included cost per LY, cost per QALY, proportions of persons with VB, TIPS, and all-cause mortality. EVL and BB were compared using the incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR). When considering only LYs, initial EVL exceeds the benchmark of 50,000 dollars/LY, with an ICER of 98,407 dollars. However, when quality of life (QoL) is considered, EVL is cost-effective compared to BB (ICUR of 25,548 dollars/QALY). In sensitivity analysis, EVL is cost-effective if the yearly risk of EV bleeding is > or = 0.26 (base case 0.15), the relative risk of bleeding on BB is > or = 0.69 (base case 0.58), or if the relative risk of bleeding with EVL is < 0.27 (base case 0.35). The ICUR favored EVL unless the relative risk of bleeding on BB is < 0.46, the relative risk of bleeding with EVL is > 0.46, or the time horizon is < or = 24 months. Whether EVL is "cost-effective" relative to BB therapy for primary prevention of EV bleeding depends on whether LYs or QALYs are considered. If only LYs are considered, then EVL is not cost-effective compared to BB therapy; however, if QoL is considered, then EVL is cost-effective.

• Authors: Thomas F Imperiale, Robert W Klein, Naga Chalasani
• Journal: Hepatology (Baltimore, Md.) (Hepatology) Vol. 45 Issue 4 Pg. 870-8 (Apr 2007) ISSN: 0270-9139 [Print] United States
• PMID: 17393528 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenergic beta-Antagonists

Topics

• Adrenergic beta-Antagonists (economics, therapeutic use)
• Cost-Benefit Analysis
• Esophageal and Gastric Varices (drug therapy, economics, surgery)
• Gastrointestinal Hemorrhage (prevention & control)
• Humans
• Ligation (economics)
• Models, Economic
• Quality of Life
• Vascular Surgical Procedures (economics)