 Decision Model We compared the cost-effectiveness of three strategies for the detection of large varices in patients with cirrhosis using a decision tree approach. The comparison strategies were 1 Endoscopy, 2 CT and 3 CT Endoscopy only for patients with small varices on CT. The model was contructed using Treeage Pro Suite 2007 Treeage Software, Williamstown, MA. Patients considered in this analysis are assumed to have compensated cirrhosis in whom the presence or absence of esophageal varices is not known. The decision tree assumed a two year time horizon. The efficacy and costs of the three approaches were compared using the incremental cost-effectiveness ratios ICERs. The decision tree is presented in the Appendix Figure 1 We made a number of assumptions for this analysis. The full set of assumptions are presented in the appendix Table 1. We assumed the sensitivity of testing strategies and subsequent complication and bleeding rates from various sources. The sensitivity of detection of large varices with CT was derived from the results presented in this paper. The analysis was conducted from the perspective of a third party payer, considering only direct health care costs. Costs were not discounted due to the relatively short time horizon of the analysis two years. The main outcome of the analysis was the cost per variceal bleed prevented. The incremental cost-effectiveness ratios ICER were calculated compared to the Do Nothing strategy. 