Cost Effectiveness of the Baveno VI Criteria Compared With Endoscopy for High-Risk Varices in Patients With Child-Pugh A Cirrhosis

Abstract

While upper GI endoscopy (EGD) remains the gold standard for detecting varices in cirrhosis, the Baveno VI criteria proposed a combination of transient elastography and platelet count that could rule out high-risk varices, therefore sparing the need of an endoscopy, with significant potential cost savings. We performed a cost-effectiveness analysis of the Baveno VI criteria compared to EGD in the diagnosis of high-risk varices in cirrhosis. We built an analytical decision model to estimate the cost and benefits of using the Baveno VI criteria compared to EGD in patients with Child Pugh A cirrhosis. The analysis was performed from the UK National Health Service (NHS) perspective, over one, five, and 20 years. A Markov model was populated with data from published evidence. Outcomes were measured in terms of Quality Adjusted Life Years (QALYs) and avoided deaths. The analyses were repeated for Canada and Spain, using relevant cost inputs. The Baveno VI criteria were cost-effective compared to endoscopy in all analyses. Over 1000 patients, they produced 0.16 additional QALYs at an incremental cost of £326 ($443.41) over five years, resulting in an incremental cost of £2,081 ($2,830) per additional QALY gained. The Incremental Net Monetary Benefit of Baveno VI compared to EDG was £2,808 ($3,819) over five years per patient. Baveno VI were also cost-effective in Canada and Spain. Deterministic and probabilistic sensitivity analysis supported these findings. The findings demonstrate that the Baveno VI criteria are cost-effective, suggesting that they should be considered for widespread implementation on the basis of safety, appropriateness and economic grounds.