Cost-effectiveness of ligation vs. beta-blockers in the prevention of variceal bleeding

Ligation is cost-effective if quality of life-years are considered
Endoscopic variceal ligation is cost-effective relative to beta-blockers for the prevention of variceal bleeding in cirrhotic patients if quality of life-years are considered. If only life-years are considered, then endoscopic variceal ligation is not cost-effective. These findings are published in the April issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD). Published by John Wiley & Sons, Inc., Hepatology is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.
Thirty to forty percent of patients with cirrhosis have esophageal varices. Bleeding from varices occurs in almost one in three of these patients and can be fatal. Non-selective beta-adrenergic blockade has been the most widely investigated therapy to reduce the risk of variceal bleeding. Another effective alternative is endoscopic variceal ligation. The effects of both treatment options on mortality are uncertain.
Since both approaches reduce the risk of variceal bleeding, researchers led by Thomas Imperiale, MD, of Indiana University School of Medicine, sought to compare their cost-effectiveness and quality of life outcomes.
They developed a Markov decision model for patients with cirrhosis, portal hypertension, and medium-to-large esophageal varices who would be candidates for primary prophylaxis with either beta-blockade or ligation. Using a 5-year time horizon, they examined direct costs, life-years, and quality-adjusted life years.