title: Economic modelling of early transjugular intrahepatic portosystemic shunt insertion for acute variceal haemorrhage.
abstract: BACKGROUND
  Early insertion of transjugular intrahepatic portosystemic shunt (TIPS) in high-risk patients with acute variceal haemorrhage reduces rebleeding and mortality. However, the economic benefit of utilizing this approach remains unclear. We evaluated the economic implications of introducing early TIPS into routine algorithms for the management of variceal bleeding.
  
  
  METHODS
  Consecutive patients admitted in 2009 with variceal haemorrhage to two liver units and eligible for early TIPS insertion were identified retrospectively. The costs of a 12-month follow-up from index bleeding admission were calculated--the actual cost of follow-up and rebleeding in this cohort was compared with the theoretical 12-month follow-up costs of instead inserting an early TIPS at index admission. Our findings were subjected to a sensitivity analysis to assess the cost effectiveness of early TIPS insertion compared with standard care.
  
  
  RESULTS
  In 2009, 78 patients were admitted to our units with variceal haemorrhage; 27 patients (35%) were eligible for early TIPS insertion. The actual cost of a 12-month follow-up was £138 473.50. Early TIPS insertion, assuming a 3.2% rebleeding rate, would save £534.70 per patient per year (P<0.0001). On sensitivity analysis, early TIPS dominated standard care up to an early TIPS rebleeding rate of 6% and remained cost-effective up to a rebleeding rate of 12%.
  
  
  CONCLUSIONS
  Early TIPS insertion for high-risk patients with acute variceal bleeding is a cost-efficient intervention. This has important implications for the introduction of early TIPS as standard care and the organization of interventional radiology services.
authors.affiliation: National Institute for Health Research NDDC Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Harman
authors.forename: Roger B
authors.initials: RB
authors.lastname: McCorry
authors.forename: Ruth P
authors.initials: RP
authors.lastname: Jacob
authors.forename: Teegan R
authors.initials: TR
authors.lastname: Lim
authors.forename: Richard
authors.initials: R
authors.lastname: O'Neill
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Ryder
authors.forename: Martin W
authors.initials: MW
authors.lastname: James
authors.forename: Guruprasad P
authors.initials: GP
authors.lastname: Aithal
authors.forename: Indra N
authors.initials: IN
authors.lastname: Guha
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000465:Algorithms; D003362:Cost-Benefit Analysis; D061345:Early Medical Intervention / Q000191:economics* / Q000379:methods; D004739:England; D004932:Esophageal and Gastric Varices / Q000191:economics / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000191:economics / Q000517:prevention & control / Q000601:surgery*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000191:economics*; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome