Sharon W Kwan1, Stephen K Allison2, Laura S Gold3, David S Shin4. 1. Comparative Effectiveness, Cost, and Outcomes Research Center, Department of Radiology, University of Washington, Seattle, Washington; Department of Interventional Radiology, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA 98195. 2. Department of Interventional Radiology, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA 98195. Electronic address: sallison@uw.edu. 3. Comparative Effectiveness, Cost, and Outcomes Research Center, Department of Radiology, University of Washington, Seattle, Washington. 4. Department of Interventional Radiology, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA 98195.
Abstract
PURPOSE: To compare relative cost-effectiveness of serial large-volume paracentesis (LVP) and transjugular intrahepatic portosystemic shunt (TIPS) creation for treatment of refractory ascites. MATERIALS AND METHODS: A decisional Markov model was developed to estimate payer cost and quality-adjusted life-ears (QALYs) associated with LVP and TIPS treatment strategies for cirrhotic patients with refractory ascites. Survival estimates were derived from an individual patient-level meta-analysis of prospective randomized clinical trials. Health utilities for potential health states were derived from a prospective study of patients with cirrhosis. Cost data were derived from national representative claims databases (MarketScan and Medicare) and included reimbursement amounts for relevant procedures, hospitalizations, and outpatient pharmaceutical costs. One-way and probabilistic sensitivity analyses were performed. RESULTS: LVP resulted in 1.72 QALYs gained at a cost of $41,391, whereas TIPS resulted in 2.76 QALYs gained at a cost of $100,538. Incremental cost-effectiveness ratio of TIPS versus LVP was $57,003/QALY. At a willingness-to-pay ratio of $100,000/QALY, TIPS has a 62% probability of being acceptable compared with LVP. CONCLUSIONS: This study suggests that TIPS should be considered cost-effective in a country that places a relatively high value on health improvements but less so in countries with lower levels of health care resources. Published by Elsevier Inc.
PURPOSE: To compare relative cost-effectiveness of serial large-volume paracentesis (LVP) and transjugular intrahepatic portosystemic shunt (TIPS) creation for treatment of refractory ascites. MATERIALS AND METHODS: A decisional Markov model was developed to estimate payer cost and quality-adjusted life-ears (QALYs) associated with LVP and TIPS treatment strategies for cirrhoticpatients with refractory ascites. Survival estimates were derived from an individual patient-level meta-analysis of prospective randomized clinical trials. Health utilities for potential health states were derived from a prospective study of patients with cirrhosis. Cost data were derived from national representative claims databases (MarketScan and Medicare) and included reimbursement amounts for relevant procedures, hospitalizations, and outpatient pharmaceutical costs. One-way and probabilistic sensitivity analyses were performed. RESULTS: LVP resulted in 1.72 QALYs gained at a cost of $41,391, whereas TIPS resulted in 2.76 QALYs gained at a cost of $100,538. Incremental cost-effectiveness ratio of TIPS versus LVP was $57,003/QALY. At a willingness-to-pay ratio of $100,000/QALY, TIPS has a 62% probability of being acceptable compared with LVP. CONCLUSIONS: This study suggests that TIPS should be considered cost-effective in a country that places a relatively high value on health improvements but less so in countries with lower levels of health care resources. Published by Elsevier Inc.
Authors: Pere Ginès; Juan Uriz; Blas Calahorra; Guadalupe Garcia-Tsao; Patrick S Kamath; Luis Ruiz Del Arbol; Ramón Planas; Jaime Bosch; Vicente Arroyo; Juan Rodés Journal: Gastroenterology Date: 2002-12 Impact factor: 22.682
Authors: Tamara Nordmann; Stefan Schlabe; Torsten Feldt; Federico Gobbi; Andreas Krieg; Johannes G Bode; Andre Fuchs; Christian Kraef; Michael Praktiknjo; Jonel Trebicka; Michael Ramharter; Marylyn M Addo; Christian Strassburg; Ansgar W Lohse; Tom Luedde; Stefan Schmiedel; Hans Martin Orth Journal: PLoS Negl Trop Dis Date: 2021-12-21