Im. Gralnek et al., The economic impact of esophageal variceal hemorrhage: Cost-effectiveness implications of endoscopic therapy, HEPATOLOGY, 29(1), 1999, pp. 44-50
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 accept
ed, community standards of endoscopic treatment of patients with EVH. Howev
er, 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 va
riceal rebleeding and patient survival at 1-year follow-up. Treatment group
s were similar in incidence of variceal rebleeding (41.9% vs. 42.9%), varic
eal obliteration (41.9% vs. 40.0%), hospital days, blood transfusions, shun
t requirements, and survival (71.0% vs. 60.0%). There were significantly mo
re treatment failures for active bleeding using EL (42% vs. 0%; P =.027) an
d 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 ther
apy for EVH must still rely on clinical grounds. Further studies comparing
costs and resource utilization in this patient population are needed.