Cost of treating an episode of variceal bleeding in a VA setting

OBJECTIVES: The specific aims of this study were to develop a demographic d escription of a sample of patients presenting with bleeding esophageal vari ces and determine the direct health care costs of variceal bleeding. METHODS: This was a retrospective evaluation of patients who underwent esop hagogastroduodenoscopy at the Portland VA Medical Center between January 19 93 and May 1997. Data sources included both electronic databases and patien t medical charts. The primary unit of analysis was an episode of care, defi ned as an index bleed plus 6 months of follow-up or death, whichever came f irst. RESULTS: The total inpatient direct cost was $1,566,904 and outpatient dire ct cost was $104,611, for a total of $1,671,515 for 100 bleeding episodes i n 79 patients. Episodes of care for patients receiving less than or equal t o 2 units of packed red blood cells were approximately a third as costly as those receiving >2 units of packed red blood cells (n = 17, $6,470 and n = 83, $17,553). The difference in costs was statistically significant (p < 0 .05), and primarily attributable to hospital bed costs. CONCLUSIONS: There is a substantial financial burden associated with this i llness, primarily attributable to inpatient costs. In addition to severity of bleeding, Child's class, endoscopic findings, and the timing of pharmaco logical therapy seem to influence the overall cost of managing esophageal v arices. (C) 2000 by Am. Coll. of Gastroenterology.