Cost-effectiveness analysis of the terlipressin-glycerin trinitrate combination in the pre-hospital management of acute gastro-intestinal haemorrhagein cirrhotic patients

Objectives:To assess the cost-effectiveness of an early treatment of upper gastro-intestinal haemorrages in cirrhotic patients. Design: Utilization da ta linked to the results of a double-blind, placebo-controlled trial demons trating the efficacy of the terlipressin-glycerin trinitrate combination (T ER-GTN) in the reduction of mortality at day 42 for haemorragic patients du e to rupture of oesophageal varices Setting: Hopital Jean Verdier, Bondy, Assistance Publique-Hopitaux de Paris , France. Subjects: Eighty-four patients included over 2 years by emergency services and hospitalized in an intensive care unit (ICU) for haemorrage, 41 in the "treated" group and 43 in the "placebo" group. Main outcome measures: Mortality at day 42, cost per death avoided. Results : The mortality rate in the placebo group was 46.5 % versus 27.5 % in the t reated group. The mean length of stay was 5 days longer in the treatment gr oup. The excess cost per death avoided was 25,849 FF Of this extra cost 27 % was due to treatment and 24 % was due to increased length of stay. The ex cess cost per case treated was FF 5,097, 10 % of the total cost per stay fo r rupture of oesophageal varices (ROV). Conclusions: Our results are of the same magnitude as those published by Ma c Cormick ct al, in the United Kingdom for similar treatment. The extra cos t appears to be moderate, and much lower than monoclonal antibody therapy f or sepsis. The impact on the study hospital budget did not exceed 1.7 10(-4 ).