Publications

@article{Mattock2021-fz,

title = {Economic evaluation of covered stents for transjugular 

 intrahepatic portosystemic stent shunt in patients with variceal 

 bleeding and refractory ascites secondary to cirrhosis},

author = {Richard Mattock and Dhiraj Tripathi and Frank O'Neill and Joyce Craig and Jennifer Tanner and David Patch and Guruprasad Aithal},

year  = {2021},

date = {2021-08-01},

journal = {BMJ Open Gastroenterol.},

volume = {8},

number = {1},

pages = {e000641},

publisher = {BMJ},

abstract = {OBJECTIVES: Transjugular intrahepatic portosystemic stent shunt 

 (TIPSS) is clinically effective in variceal bleeding and 

 refractory ascites; however, the cost-effectiveness of TIPSS has 

 yet to be evaluated in the UK. This study aimed to establish the 

 cost-effectiveness of (i) pre-emptive TIPSS versus endoscopic 

 band ligation (EBL) in populations with variceal bleeding and 

 (ii) TIPSS versus large volume paracentesis (LVP) in refractory 

 ascites. METHODS: A cost-utility analysis was conducted with the 

 perspective including healthcare costs and quality-adjusted life 

 years (QALYs). A Markov model was constructed with a 2-year time 

 horizon, health states for mortality and survival and 

 probabilities for the development of variceal bleeding, ascites 

 and hepatic encephalopathy. A survival analysis was conducted to 

 extrapolate 12-month to 24-month mortality for the refractory 

 ascites indication. Uncertainty was analysed in deterministic 

 and probabilistic sensitivity analyses. RESULTS: TIPSS was 

 cost-effective (dominant) and cost saving for both indications. 

 For variceal bleeding, pre-emptive TIPSS resulted in 0.209 

 additional QALYs, and saved pounds600 per patient compared 

 with EBL. TIPSS had a very high probability of being 

 cost-effective (95%) but was not cost saving in scenario 

 analyses driven by rates of variceal rebleeding. For refractory 

 ascites, TIPSS resulted in 0.526 additional QALYs and saved 

 pounds17 983 per patient and had a 100% probability of being 

 cost-effective and cost saving when compared with LVP. 

 CONCLUSIONS: TIPSS is a cost-effective intervention for variceal 

 bleeding and refractory ascites. TIPSS is highly cost-saving for 

 refractory ascites. Robust randomised trial data are required to 

 confirm whether pre-emptive TIPSS is cost saving for variceal 

 bleeding.},

keywords = {ascites, bleeding, cost-effectiveness, economic evaluation, liver cirrhosis},

pubstate = {published},

tppubtype = {article}

}