The budget impact of endoscopic screening for esophageal varices in cirrhosis.
BACKGROUND
The cost-effectiveness of screening for esophageal varices in cirrhosis remains uncertain. Previous analyses found that screening with upper endoscopy (EGD) may not be cost effective versus empiric beta-blocker (BB) therapy. However, these models were conducted before advances in variceal screening, including capsule endoscopy (CE), and they did not measure the budget impact (vs cost-effectiveness) of variceal screening.


OBJECTIVE
To compare the managed care budget impact of variceal screening strategies.


METHODS
Budget impact model.


METHODS
Hypothetical managed care organization with 1 million covered lives.


METHODS
Patients with compensated cirrhosis.


METHODS
Compared 5 strategies: (1) empiric BB, (2) screening EGD followed by BB if varices present (EGD --> BB), (3) EGD followed by endoscopic band ligation if varices present (EGD --> EBL), (4) CE followed by BB if varices present (CE --> BB), and (5) CE followed by EBL if varices present (CE --> EBL).


METHODS
Per-member per-month cost.


RESULTS
BB was the least expensive, and CE --> EBL was the most expensive. Substituting CE --> BB in lieu of BB cost each member an additional $0.20 per month to subsidize. Compared with CE --> BB, both EGD-based strategies were more expensive. However, CE was not viable in managed care organizations capable of reducing the cost of endoscopy below $410, unless the cost of CE was reduced in lockstep.


CONCLUSIONS
Data on CE remain limited.


CONCLUSIONS
Screening for varices may have an acceptable budget impact but is highly sensitive to local costs of EGD and CE. In managed care organizations willing to subsidize EBL for variceal prophylaxis, it is inefficient to screen with CE compared with EGD.
Spiegel
Brennan M R
BM
Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, UCLA/VA Center for Outcomes Research and Education (CORE), 11301 Wilshire Blvd, Bldg 115 Rm 215, Los Angeles, CA 90073, USA.
Esrailian
Eric
E
Eisen
Glenn
G
D002017:Budgets; D003365:Costs and Cost Analysis / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000191:economics*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000191:economics / Q000209:etiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000191:economics; D008329:Managed Care Programs / Q000191:economics*; D018803:Models, Economic; D014481:United States