TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT VERSUS H-GRAFT PORTACAVAL-SHUNT IN THE MANAGEMENT OF BLEEDING VARICES - A COST-BENEFIT-ANALYSIS

Background. Transjugular intrahepatic portosystemic shunt (TIPS) is po pular in treating portal hypertension because of its perceived efficac y and cost benefits, although it has never been compared with surgical shunting in a cost-benefit analysis. This study was undertaken to det ermine the cost benefit of TIPS versus small-diameter prosthetic H-gra ft portacaval shunt (HGPCS). Methods. Cost of care was determined in 8 0 patients prospectively randomized to receive TIPS or HGPCS as defini tive treatment for bleeding varices, beginning with shunt placement an d including subsequent admissions for complications or follow-up relat ed to shunting. Results. Patients were similar in age, gender, severit y of illness/liver dysfunction, and urgency of shunting. After TIPS or HGPCS, variceal rehemorrhage (8 versus 0, respectively; p = 0.03), sh unt occlusion (13 versus 4; p = 0.03), shunt revision (16 versus 4; p < 0.005), and shunt failure (18 versus 10; p = 0.10) were compared; al l were more common after TIPS. Through the index admission, TIPS cost $48,188 +/- $43,355 whereas HGPCS cost $61,522 +/- $47,615. With follo w-up, TIPS cost $69,276 +/- $52,712 and HGPCS cost $66,034 +/- $49,118 . Conclusions. Early cost of TIPS was less than, though not different from, cost of HGPCS. With follow-up, costs after TIPS mounted. The ini tially lower cost of TIPS is offset by higher rates of subsequent occl usion and rehemorrhage.