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Economic modelling of early transjugular intrahepatic portosystemic shunt insertion for acute variceal haemorrhage
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Harman, David J., McCorry, Roger B., Pulikottil-Jacob, Ruth, Lim, Teegan R., O’Neill, Richard, Ryder, Stephen D., James, Martin W., Aithal, Guruprasad P. and Guha, Indra N. (2013) Economic modelling of early transjugular intrahepatic portosystemic shunt insertion for acute variceal haemorrhage. European Journal of Gastroenterology and Hepatology, 25 (2). pp. 201-207. doi:10.1097/MEG.0b013e32835a4cb0 ISSN 0954-691X.
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Official URL: http://dx.doi.org/10.1097/MEG.0b013e32835a4cb0
Abstract
Introduction:
Early insertion of transjugular intrahepatic portosystemic shunt (TIPS) in high-risk patients with acute variceal haemorrhage reduces rebleeding and mortality. However, the economic benefit of utilizing this approach remains unclear. We evaluated the economic implications of introducing early TIPS into routine algorithms for the management of variceal bleeding.
Methods:
Consecutive patients admitted in 2009 with variceal haemorrhage to two liver units and eligible for early TIPS insertion were identified retrospectively. The costs of a 12-month follow-up from index bleeding admission were calculated--the actual cost of follow-up and rebleeding in this cohort was compared with the theoretical 12-month follow-up costs of instead inserting an early TIPS at index admission. Our findings were subjected to a sensitivity analysis to assess the cost effectiveness of early TIPS insertion compared with standard care.
Results:
In 2009, 78 patients were admitted to our units with variceal haemorrhage; 27 patients (35%) were eligible for early TIPS insertion. The actual cost of a 12-month follow-up was £138 473.50. Early TIPS insertion, assuming a 3.2% rebleeding rate, would save £534.70 per patient per year (P<0.0001). On sensitivity analysis, early TIPS dominated standard care up to an early TIPS rebleeding rate of 6% and remained cost-effective up to a rebleeding rate of 12%.
Conclusion:
Early TIPS insertion for high-risk patients with acute variceal bleeding is a cost-efficient intervention. This has important implications for the introduction of early TIPS as standard care and the organization of interventional radiology services.
Item Type: | Journal Article | ||||
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Subjects: | R Medicine > RC Internal medicine | ||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Reproductive Health ( - until July 2016) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Hepatic encephalopathy | ||||
Journal or Publication Title: | European Journal of Gastroenterology and Hepatology | ||||
Publisher: | Lippincott Williams & Wilkins, Ltd. | ||||
ISSN: | 0954-691X | ||||
Official Date: | February 2013 | ||||
Dates: |
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Volume: | 25 | ||||
Number: | 2 | ||||
Number of Pages: | 7 | ||||
Page Range: | pp. 201-207 | ||||
DOI: | 10.1097/MEG.0b013e32835a4cb0 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Restricted or Subscription Access |
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