TERLIPRESSIN VERSUS NORADRENALINE FOR HEPATORENAL SYNDROME. Economic evaluation under the perspective of the Brazilian Public Health System.
BACKGROUND
- Terlipressin and noradrenaline are the best studied treatments for hepatorenal syndrome, and there is no evidence of superiority of one over the other regarding to efficacy. While the former drug is more costly, the latter requires admission into an intensive care unit.


OBJECTIVE
- The aim of this study was to perform an economic evaluation, comparing treatments for hepatorenal syndrome with terlipressin and noradrenaline.


METHODS
- For the economic evaluation, a cost-minimization analysis was performed. Direct medical costs of the two treatment strategies were compared under the perspective of the Brazilian Public Health System as the third-party payer. A probabilistic sensitivity analysis was performed.


RESULTS
- The costs of treatments with terlipressin or noradrenaline were 287.77 and 2,960.45 International Dollars (Int$) respectively. Treatment using terlipressin would save Int$2,672.68 for the Public Health System for each hospital admission related to hepatorenal syndrome. In the probabilistic sensitivity analysis, it was verified that the cost of the treatment with noradrenaline could vary between Int$2,326.53 and Int$3,644.16, while costs related to the treatment using terlipressin are not variable.


CONCLUSIONS
- The treatment strategy using terlipressin was more economical than that using noradrenaline under the perspective of the Brazilian Public Health System as the third-party payer.
Programa de Pós-Graduação em Hepatologia da Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brasil; , Universidade Federal de Ciências da Saúde de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, RS , Brazil.|Irmandade Santa Casa de Misericórdia de Porto Alegre, RS, Brasil; , Irmandade Santa Casa de Misericórdia de Porto Alegre, RS , Brasil.|Hospital Nossa Senhora da Conceição, RS, Brasil; , Hospital Nossa Senhora da Conceição, Hospital Nossa Senhora da Conceição, RS , Brazil.
Ângelo Zambam de
ÂZ
Mattos
Programa de Pós-Graduação em Hepatologia da Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brasil; , Universidade Federal de Ciências da Saúde de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, RS , Brazil.|Irmandade Santa Casa de Misericórdia de Porto Alegre, RS, Brasil; , Irmandade Santa Casa de Misericórdia de Porto Alegre, RS , Brasil.
Angelo Alves de
AA
Mattos
Instituto para Avaliação de Tecnologias em Saúde, Brasil; , Instituto para Avaliação de Tecnologias em Saúde, Brasil.|Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul, RS, Brasil., Universidade Federal do Rio Grande do Sul, Universidade Federal do Rio Grande do Sul, RS , Brazil.
Rodrigo Antonini
RA
Ribeiro
D001938:Brazil; D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006530:Hepatorenal Syndrome / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D008236:Lypressin / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D009638:Norepinephrine / Q000191:economics* / Q000627:therapeutic use; D011634:Public Health / Q000191:economics*; D000077585:Terlipressin; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000191:economics* / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D009638:Norepinephrine