[A cost-effectiveness study of hepatic venous pressure gradient measurement in the secondary prevention of variceal bleeding].
OBJECTIVE
variceal rebleeding is common following a first episode of hemorrhage in cirrhotic patients. The objective of this study was to determine the cost-effectiveness of monitoring hepatic venous pressure gradient (HVPG) to guide secondary prophylaxis.


METHODS
we created a Markov decision model to calculate cost-effectiveness for two strategies: Group 1: HVPG monitoring to decide treatment -when portal pressure was reduced by at least 20 percent or HVPG was less than 12 mmHg after beta-blocker administration, patients received beta-blockers; when portal pressure did not meet these criteria therapy was endoscopic band ligation. Group 2: in this group there was no monitoring of HVPG. Patients with large varices received treatment with beta-blockers combined with EBL; patients with small varices received beta-blockers plus isosorbide mononitrate.


RESULTS
there was no recurrent variceal bleeding in group 1 for good responders, and for 17% of poor responders. In group 2 a 25% rebleeding rate was detected in patients with small varices and 13% for those with big varices. Overall cost in group 1 was 14,100.49 euros, and 14,677.16 in group 2.


CONCLUSIONS
HVPG measurement is cost-effective for the secondary prophylaxis of variceal bleeding.
Amorós
A
A
Unidad Hepática y Servicio de Farmacología. Hospital General Universitario de Alicante. Universidad Miguel Hernández, Alicante, Spain. amparoamoros@hotmail.com
Palazón
J M
JM
Zapater
P
P
de Madaria
E
E
Pérez-Mateo
M
M
D001795:Blood Pressure Determination / Q000191:economics*; D003362:Cost-Benefit Analysis; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D006503:Hepatic Veins / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention