Cirrhosis cost-effectiveness of therapy

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

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.

• 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.

[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.