Decision-analysis of transjugular intrahepatic portosystemic shunt versus distal splenorenal shunt for portal hypertension

Transjugular intrahepatic portosystemic shunt (TIPS) and surgical distal sp lenorenal shunt (DSRS) are treatments for complications of portal hypertens ion. TIPS is widely used because it is relatively easy to place. Because TI PS may malfunction over time, it is unclear whether TIPS is superior to DSR S in patients with Child's class A cirrhosis who enjoy a longer survival. T his study compared the cost-effectiveness of TIPS to DSRS for portal hypert ension in Child's class A cirrhosis. A decision analysis model was used to evaluate the number of procedures, life expectancy, and costs over the firs t 2 years in patients with Child's class A cirrhosis who underwent a TIPS o r DSRS, Patients who received TIPS survived 1.96 years, required 1.7 proced ures, and incurred $41,685 in costs. Patients who underwent a DSRS survived 1.86 years, required 1.0 procedure, and incurred $26,951 in costs. The cos t-effectiveness of TIPS compared with DSRS was $147,340 per life-year saved . Adjusting the rate of TIPS dysfunction, 1-year survival, or the number of ultrasounds to detect TIPS dysfunction did not change the results. In pati ents with Child's class A cirrhosis, DSRS is a more cost-effective treatmen t than TIPS. Until the results of a randomized controlled trial comparing T IPS with DSRS are available, TIPS should be regarded as experimental and pr ohibitively expensive in Child's class A cirrhosis.