Cost-effectiveness analysis of preventing esophageal variceal rebleeding in liver cirrhosis

Abstract

Objective To compare cost-effectiveness between endoscopical esophageal variceal ligation (EVL) combined non-selective beta-receptor blocker strategies and covered-stents transjugular intrahepatic portosystemic shunt (cTIPS) in preventing esophageal variceal rebleeding in liver cirrhosis with portal hypertension. And to explore the threshold of cost-effectiveness in stents in China. Methods According to clinical practice and associated guidelines, a six state Markov-based decision analytic model was established with TreeAge Pro Suite 2014 to compare the cost-effectiveness between two interfering strategies after followed up for seven years. The parameters such as costs, life years (LY), quality-adjusted life-years (QALY) and incremental cost-effectiveness ratio (ICER) were directed. Results The results of baseline research in the seven-year follow-up period indicated that the cost of endoscopical EVL combined non-selective beta-receptor blocker B was 7 444.25 United States dollar (USD)/each, and yielded 1.98 QALY. The expected cost of cTIPS was 13 151.69 USD/each and could have 2.34 QALY. In the 7th year, ICER was 16 001.74 USD. Based on willingness-to-pay (WTP) threshold of China (19 887.00 USD), cTIPS had better cost-effectiveness than endoscopical EVL combined non-selective beta-receptor blocker B. The price of covered stents less than 5 401.52 USD had cost-effectiveness. The results of single factor sensitivity analysis indicated that rebleeding probability of endoscopical EVL combined non-selective beta-receptor blocker B group was the most influential factor in the result of model. The second important factor was the cost of cTIPS. The probabilistic sensitivity analysis reported cTIPS to be the optimal strategy at WTP of 19 887.00 USD in 83% of the iterations. Conclusions Seven-year follow-up indicates that cTIPS may be a more cost-effective strategy than endoscopical EVL combined non-selective beta-receptor blocker B in preventing esophageal variceal rebleeding. The price of covered stents less than 5 401.52 USD which have cost-effectiveness in China. Key words: Portasystemic shunt, transjugular intrahepatic; Covered stents; Esophageal variceal ligation; Non-selective beta-blocker; Markov model; Cost-effectiveness analysis; Probability senstivity analysis