Cost-effectiveness analysis of transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic therapy for the prevention of recurrent esophageal variceal bleeding

For the prevention of recurrent esophageal variceal bleeding, studies show that patients treated with transjugular intrahepatic portosystemic shunt (T IPS) have lower rebleeding rates compared with endoscopic therapy. However, TIPS is associated with higher rates of portosystemic encephalopathy and p ossibly higher costs, The aim of this study was to conduct a cost-effective ness analysis comparing TIPS with endoscopic sclerotherapy and endoscopic l igation for the prevention of recurrent esophageal variceal bleeding. Data for rates of rebleeding, death, complications, and crossover from endoscopy to TIPS were obtained from the literature. Costs for procedures and hospit alizations were obtained from two medical centers. Sensitivity analyses wer e performed varying probabilities of key variables. The patient population consisted of a hypothetical cohort of cirrhotic patients successfully treat ed for esophageal variceal bleeding with endoscopic sclerotherapy who recei ved prophylactic sclerotherapy, ligation, or TIPS over 1 year. Endoscopic p atients would receive propranolol. Mortality was similar for the three grou ps. The number of bleeds per patient for sclerotherapy, ligation, and TIPS would be 0.39, 0.32, and 0.07, respectively. The total annual costs per pat ient for sclerotherapy, ligation, and TIPS were $23,459, $23,111, and $26,2 75, respectively. The incremental cost per bleed prevented for TIPS compare d with sclerotherapy and ligation was $8,803 and $12,660, respectively. The incremental cost per bleed prevented for TIPS compared with sclerotherapy or ligation was sensitive to the cost of TIPS and the TIPS stenosis rate. L igation had lower costs and lower recurrent bleeding rates than sclerothera py. Compared with endoscopic therapy, TIPS leads to lower recurrent varicea l bleeding rates and it is more cost effective in the short term for the pr evention of recurrent esophageal variceal bleeding.