Cirrhosis cost-effectiveness of therapy: Difference between revisions
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* [[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 [[Transjugular intrahepatic portosystemic shunt|TIPS]] vs [[Distal splenorenal shunt procedure| | ===Role of [[Transjugular intrahepatic portosystemic shunt|TIPS]] vs [[Distal splenorenal shunt procedure|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. | 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. | * 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. | ||
Revision as of 16:35, 6 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.
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 difference was felt not to be significant. Using covered rather than bare walls 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.