[Cost-effectiveness analysis of emergency endoscopic variceal ligation plus octreotide in the treatment of acute esophageal variceal bleeding in cirrhotic patients].
OBJECTIVE
To compare and evaluate the cost and effectiveness of endoscopic variceal ligation (EVL) at emergency plus octreotide versus octreotide alone in the treatment of acute esophageal variceal bleeding in cirrhotic patients.


METHODS
Seventy-eight patients with active variceal bleeding under emergency endoscope, were assigned to two groups receiving either combined therapy of EVL at emergency and octreotide ('EVL' group) or a continuous infusion of octreotide alone ('octreotide' group). Both efficacy and cost-effectiveness were observed.


RESULTS
There were no significant differences between the two groups in patients' characteristics, supporting treatment or general treatment. In group EVL, there appeared a significantly higher rate in controlling bleeding and lower complication rate than that of octreotide group(94.4% vs.78.6%, P = 0.045 and 19.4% vs. 42.9%, P = 0.027, respectively). Early rebleeding and mortality rate were also lower in group EVL, but with no significant differences between them (2.9% vs. 7.7%, P = 0.358 and 5.6% vs. 14.3%, P = 0.205, respectively). The combined therapy had a significantly shorter time of hemostasis, less administration of octreoid, fewer units of blood transfusion and shorter hospital stay (P < 0.001). The median costs of the combined therapy and octreotide alone were RMB 9046.5 Yuan and 13 743.6 Yuan,respectively (P = 0.045). The cost-effective ratio of group EVL seemed superior to that of octreoid group.


CONCLUSIONS
The therapeutic scheme of emergency EVL plus octreotide was a more cost-effective one for controlling acute esophageal variceal bleeding.
Zhang
Ying
Y
Department of Gastroenterology, Huadong Hospital, Shanghai 200040, China.
Chen
Shi-yao
SY
Yu
Xiao-feng
XF
Zhao
Shang-min
SM
Wang
Yi-qian
YQ
D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008026:Ligation / Q000191:economics; D008103:Liver Cirrhosis / Q000150:complications*; D015282:Octreotide / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
D015282:Octreotide