Cost of preventing variceal rebleeding with transjugular intrahepatic portal systemic shunt and distal splenorenal shunt.
OBJECTIVE
We examined the cost and cost effectiveness of distal splenorenal shunt (DSRS) and transjugular intrahepatic portosystemic shunt (TIPS) in the prevention of variceal rebleeding.


METHODS
Patients participated in a randomized controlled trial comparing DSRS to TIPS. Quality of life (QOL) was measured using SF-36 preceding randomization and yearly thereafter. Cost utility analysis was performed using TreeAge DATA. Costs for both in- and out-patient events and interventions were obtained for each patient. Costs using coated stents were estimated using different rates of stenosis. Incremental cost effectiveness ratios (ICERs) were determined at 1, 3 and 5 years.


RESULTS
The average yearly costs of managing patients after TIPS and DSRS over 5 years were similar, $16,363 and $13,492, respectively. Cost of TIPS for surviving patients exceeded the cost of DSRS at years 3 and 5 but not significantly. ICERs per life saved favored TIPS at year 5 ($61,000). If coated rather than bare stents were used the cost effectiveness of TIPS increased slightly.


CONCLUSIONS
TIPS is as effective as DSRS in preventing variceal rebleeding and may be more cost effective. TIPS, in all aspects, is equal to DSRS in the prevention of variceal rebleeding in patients who are medical failures.
Department of Medicine, University of Arizona, Liver Research Institute, Tucson, AZ 85724, USA. tboyer@deptofmed.arizona.edu
Thomas D
TD
Boyer
J Michael
JM
Henderson
Adrienne M
AM
Heerey
Susana
S
Arrigain
Vicky
V
Konig
Jason
J
Connor
Kareem
K
Abu-Elmagd
John
J
Galloway
Layton F
LF
Rikkers
Lennox
L
Jeffers
D003362:Cost-Benefit Analysis; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery*; D006801:Humans; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000191:economics*; D019057:Quality-Adjusted Life Years; D016879:Salvage Therapy / Q000191:economics / Q000379:methods; D055502:Secondary Prevention; D013164:Splenorenal Shunt, Surgical / Q000191:economics*; D015607:Stents; D016896:Treatment Outcome