Vasoconstrictors in the management of bleeding from oesophageal varices. A clinico-economic appraisal in the UK.
BACKGROUND
Bleeding from oesophageal varices is an uncommon but potentially fatal condition that often leads to expensive hospitalizations in intensive care or high-dependency units.


METHODS
To assess the clinical and economic impact of this condition, we have devised a management plan illustrating current clinical practice in the UK.


RESULTS
Approximately 6.1 million pounds of NHS resources are devoted to the treatment of 3000 acute hospital admissions for variceal bleeding every year. Vasoconstrictors like vasopressin may save approximately 36 lives per annum for an additional 145 thousand pounds. However, current clinical practice requires vasopressin to be concurrently administered with intravenous glyceryl trinitrate, increasing overall costs by 582 thousand pounds to a total of 6.7 million pounds. The additional cost for each extra life saved is estimated at 16,180 pounds.


CONCLUSIONS
The efficacy of current vasoconstrictors requires further confirmation. In particular, new agents like octreotide (Sandostatin) should be carefully assessed to determine their potential clinical and economic benefits.
McCormick
P A
PA
University Dept. of Medicine, Royal Free Hospital, London, UK.
Greenslade
L
L
Matheson
L A
LA
Matsaganis
M
M
Bosanquet
N
N
Burroughs
A K
AK
D000208:Acute Disease; D003365:Costs and Cost Analysis; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000191:economics*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D005996:Nitroglycerin / Q000191:economics / Q000627:therapeutic use; D010347:Patient Care Planning; D006113:United Kingdom; D014662:Vasoconstrictor Agents / Q000191:economics / Q000627:therapeutic use*; D014667:Vasopressins / Q000191:economics / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D014667:Vasopressins; D005996:Nitroglycerin