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Randomized Controlled Trial
. 2008 Mar;48(3):407-14.
doi: 10.1016/j.jhep.2007.08.014. Epub 2007 Oct 23.

Cost of preventing variceal rebleeding with transjugular intrahepatic portal systemic shunt and distal splenorenal shunt

Thomas D Boyer  1 , J Michael Henderson, Adrienne M Heerey, Susana Arrigain, Vicky Konig, Jason Connor, Kareem Abu-Elmagd, John Galloway, Layton F Rikkers, Lennox Jeffers; DIVERT Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Cost of preventing variceal rebleeding with transjugular intrahepatic portal systemic shunt and distal splenorenal shunt

Thomas D Boyer et al. J Hepatol. 2008 Mar.

Abstract

Background/aims: We examined the cost and cost effectiveness of distal splenorenal shunt (DSRS) and transjugular intrahepatic portosystemic shunt (TIPS) in the prevention of variceal rebleeding.

Methods: Patients participated in a randomized controlled trial comparing DSRS to TIPS. Quality of life (QOL) was measured using SF-36 preceding randomization and yearly thereafter. Cost utility analysis was performed using TreeAge DATA. Costs for both in- and out-patient events and interventions were obtained for each patient. Costs using coated stents were estimated using different rates of stenosis. Incremental cost effectiveness ratios (ICERs) were determined at 1, 3 and 5 years.

Results: The average yearly costs of managing patients after TIPS and DSRS over 5 years were similar, $16,363 and $13,492, respectively. Cost of TIPS for surviving patients exceeded the cost of DSRS at years 3 and 5 but not significantly. ICERs per life saved favored TIPS at year 5 ($61,000). If coated rather than bare stents were used the cost effectiveness of TIPS increased slightly.

Conclusions: TIPS is as effective as DSRS in preventing variceal rebleeding and may be more cost effective. TIPS, in all aspects, is equal to DSRS in the prevention of variceal rebleeding in patients who are medical failures.

Trial registration: ClinicalTrials.gov NCT00006161.

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Figures

Figure 1
Figure 1
Acceptability curves of incremental cost effectiveness thresholds based on Monte Carlo simulation (n=1,000) of DSRS vs TIPS in the control of refractory variceal bleeding in patients with Child’s Class A or B cirrhosis
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