title: Terlipressin versus noradrenaline in the treatment of hepatorenal syndrome: systematic review with meta-analysis and full economic evaluation.
abstract: OBJECTIVE
  The aim of this study was to compare the efficacy and costs of terlipressin and noradrenaline for the treatment of hepatorenal syndrome from the perspective of the Brazilian public health system and that of a major private health insurance.
  
  
  METHODS
  Comparison of efficacy was performed through a systematic review with a meta-analysis of randomized-controlled trials using a random-effects model. Economic evaluation was carried out through cost minimization.
  
  
  RESULTS
  Four studies (154 patients) were included in the meta-analysis. There was no evidence of a difference between treatments with terlipressin or noradrenaline in terms of 30-day survival (risk ratio=1.04, 95% confidence interval=0.84-1.30, P=0.70). From the perspective of the public health system, costs of the treatments with terlipressin or noradrenaline were Int$7437.04 and Int$8406.41, respectively. From the perspective of the private health insurance, costs of treatments with terlipressin and noradrenaline were Int$13,484.57 and Int$15,061.01, respectively.
  
  
  CONCLUSIONS
  There was no evidence of superiority between treatment strategies using terlipressin or noradrenaline in terms of the survival of patients with hepatorenal syndrome, but the strategy using terlipressin was more economical under two different perspectives.
authors.affiliation: aPost-Graduation Course of Hepatology, Federal University of Health Sciences of Porto Alegre bGastroenterology and Hepatology Unit, Irmandade Santa Casa de Misericórdia Hospital cGastroenterology and Hepatology Unit, Nossa Senhora da Conceição Hospital dInstitute for Education and Research, Moinhos de Vento Hospital eInstitute for Health Technology Assessment fPost-Graduation Course of Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Ângelo Z de
authors.initials: ÂZ
authors.lastname: Mattos
authors.forename: Angelo A de
authors.initials: AA
authors.lastname: Mattos
authors.forename: Rodrigo A
authors.initials: RA
authors.lastname: Ribeiro
mesh_terms: D001938:Brazil; D016009:Chi-Square Distribution; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006530:Hepatorenal Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D006801:Humans; D008236:Lypressin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D018803:Models, Economic; D009638:Norepinephrine / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D000077585:Terlipressin; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D009638:Norepinephrine