Cirrhosis cost-effectiveness of therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-In-Chief: Ujjwal Rastogi, M.B.B.S. [2]

Overview

According to a report from The National Center for Health Statistics, cirrhosis and chronic liver disease accounted for more than 25,000 deaths and 373,000 hospital discharges in the United States in 1998. Therefore, cirrhosis and chronic liver disease have a huge financial impact on the health care industry.

Cost-Effectiveness of Therapy

Management of adult patients with ascites due to cirrhosis

• Abdominal paracentesis with appropriate ascitic fluid analysis is probably the most rapid and cost-effective method of diagnosing the cause of ascites.
• The risks and costs of prophylactic transfusions may exceed the benefit.
• Intravenous ciprofloxacin followed by oral administration of this drug was found to be more cost-effective compared to intravenous ceftazidime in a randomized trial in patients who had not received quinolone prophylaxis.
• Selective intestinal decontamination with norfloxacin or trimethoprim/sulfamethoxazole in patients with prior spontaneous bacterial peritonitis (SBP) or low-protein ascitic fluid does appear to be cost-effective.

Role of TIPS vs distal splenorenal shunt in the management of portal hypertension

[3]

A cost-effectiveness analysis of a randomized controlled trial comparing transjugular intrahepatic portosystematic shunt (TIPS) (bare metal Wallstents) to distal splenorenal shunt (DSRS) reported costs of both in- and out-patient care.

• The average yearly cost over a 5 year period were $16,363 for TIPS patients and $13,492 for the DSRS patients. These yearly costs are similar to what has been reported for pharmacologic and endoscopic management of patients with bleeding varices.
• TIPS was slightly more cost effective than DSRS at year five ($61,000 per life saved) but the difference was felt to be insignificant. Using covered, rather than bare wall stents, was estimated to increase the cost-effectiveness of TIPS only slightly. The authors conclude that TIPS is as effective as DSRS in the prevention of variceal rebleeding and may be slightly more cost-effective.