Document Detail

The economic impact of esophageal variceal hemorrhage: cost-effectiveness implications of endoscopic therapy.
MedLine Citation:
PMID:  9862848     Owner:  NLM     Status:  MEDLINE    
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. Treatment groups were similar in incidence of variceal rebleeding (41.9% vs. 42.9%), variceal obliteration (41.9% vs. 40.0%), hospital days, blood transfusions, shunt requirements, and survival (71.0% vs. 60.0%). There were significantly more treatment failures for active bleeding using EL (42% vs. 0%; P =.027) and esophageal stricture formation in the ES-treated patients (19.4% vs. 2.9%; P = 0.03). Median total direct cost outcomes were similar between groups (EL = $9,696 and ES = $13,197; P =.46). EL and ES had similar cost/variceal rebleeding prevented ($28,678 vs. $29,093) and cost/survival ($27,313 vs. $23,804). In the subgroup of active bleeders, ES had a substantially lower cost/survival ($28,523 vs. $51,696). We conclude that resource utilization was similar between treatment groups and that the choice of endoscopic therapy for EVH must still rely on clinical grounds. Further studies comparing costs and resource utilization in this patient population are needed.
I M Gralnek; D M Jensen; T O Kovacs; R Jutabha; G A Machicado; J Gornbein; J King; S Cheng; M E Jensen
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Hepatology (Baltimore, Md.)     Volume:  29     ISSN:  0270-9139     ISO Abbreviation:  Hepatology     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-02-03     Completed Date:  1999-02-03     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8302946     Medline TA:  Hepatology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  44-50     Citation Subset:  IM    
University of California, Los Angeles (UCLA) School of Medicine, Center for the Health Sciences, Department of Medicine, Division of Digestive Diseases, Los Angeles, CA 90095-1684, USA.
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MeSH Terms
Cost-Benefit Analysis
Direct Service Costs
Double-Blind Method
Emergency Treatment
Esophageal and Gastric Varices / complications,  economics*
Follow-Up Studies
Hemorrhage / economics*,  etiology,  therapy
Hemostasis, Endoscopic / economics*
Ligation / economics
Middle Aged
Prospective Studies
Sclerotherapy / economics*
Treatment Outcome
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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