Cost analysis for the prevention of variceal rebleeding: A comparison between transjugular intrahepatic portosystemic shunt and endoscopic sclerotherapy in a selected group of Italian cirrhotic patients

The aim of the present study was to compare the cumulative cost of the firs t 18-month period in a selected group of Italian cirrhotic patients treated with transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopi c sclerotherapy (ES) to prevent variceal rebleeding. Thirty-eight patients enrolled in a controlled trial were considered (18 TIPS and 20 sclerotherap y). The number of days spent in the hospital for the initial treatment and during the follow-up period were defined as the costs of hospitalization. E S sessions, TIPS procedures, angioplasty or addition of a second stent to m aintain the shunt patency, were defined as the costs of therapeutic procedu res. The two groups were comparable for age, sex, and Child-Pugh score. Dur ing the observation period 4 patients died in the TIPS group, and 2 died an d 1 was transplanted in the sclerotherapy group. The rebleeding rate was si gnificantly higher in the sclerotherapy group. Despite this, the number of days spent in the hospital was similar in the two groups. This was because of a higher number of hospital admissions for the treatment of hepatic ence phalopathy and shunt insufficiency in the TIPS group. The therapeutic proce dures were more expensive for TIPS. Consequently, the cumulative cost was h igher for patients treated with TIPS than for those treated with sclerother apy. The extra cost was because of the initial higher cost of the procedure and the difference was still maintained at the end of the 18-month follow- up. When the cumulative costs were expressed per month free of rebleeding, the disadvantage of TIPS disappeared. In conclusion, a program of preventio n of variceal rebleeding with TIPS, despite the longer interval free of reb leeding, is not a cost-saving strategy in comparison with sclerotherapy.