Year 2008 / Volume 100 / Number 7
Original
A cost-effectiveness study of hepatic venous pressure gradient measurement in the secondary prevention of variceal bleeding

pp. 416-422

Amorós, A. / Palazón, J. M. / Zapater, P. / de Madaria, E. / Pérez-Mateo, M.

Abstract
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.
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Amorós, A. / Palazón, J. M. / Zapater, P. / de Madaria, E. / Pérez-Mateo, M.. A cost-effectiveness study of hepatic venous pressure gradient measurement in the secondary prevention of variceal bleeding. 416-422


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