Cirrhosis cost-effectiveness of therapy: Difference between revisions
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{{CMG}} {{AOEIC}} {{UJ}} | {{CMG}} {{AOEIC}} {{UJ}} | ||
==Overview== | ==Overview== | ||
According to a report from The National Center for Health Statistics, | 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.<ref name="pmid18328931">{{cite journal| author=Schuppan D, Afdhal NH| title=Liver cirrhosis. | journal=Lancet | year= 2008 | volume= 371 | issue= 9615 | pages= 838-51 | pmid=18328931 | doi=10.1016/S0140-6736(08)60383-9 | pmc=PMC2271178 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18328931 }} </ref> Therefore, cirrhosis and chronic liver disease have a huge financial impact on the health care industry. | ||
==Cost- | |||
==Cost-Effectiveness of Therapy== | |||
===Management of adult patients with ascites due to cirrhosis=== | ===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. | * [[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. | *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. | * [[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. | * 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 | |||
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. | ===Role of TIPS vs distal splenorenal shunt in the management of portal hypertension=== | ||
[http://www.guideline.gov/content.aspx?id=15476&search=Hepatic+vein+thrombosis+] | |||
A cost-effectiveness analysis of a randomized controlled trial comparing transjugular intrahepatic portosystematic shunt ([[TIPS]]) (bare metal Wallstents) to [[Distal splenorenal shunt procedure|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. | * 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 difference was felt | * 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. | ||
== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 18:23, 7 September 2012
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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.[1] 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
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.
References
- ↑ Schuppan D, Afdhal NH (2008). "Liver cirrhosis". Lancet. 371 (9615): 838–51. doi:10.1016/S0140-6736(08)60383-9. PMC 2271178. PMID 18328931.