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document
The economic impact of esophageal variceal hemorrhage : cost-effectiveness implications of endoscopic therapy . Esophageal variceal hemorrhage ( EVH ) is a serious and expensive sequela of chronic liver disease , leading to increased utilization of resources . Today , endoscopic sclerotherapy ( ES ) and endoscopic ligation ( EL ) are the accepted , community standards of endoscopic treatment of patients with EVH . However , there are no published studies comparing the economic costs of treating EVH using these interventions . As part of a prospective , randomized trial comparing ES and EL for the treatment of EVH , we estimated the direct costs of health care utilization and cost-effectiveness for the prevention of variceal rebleeding and patient survival at 1-year follow-up . Treatment groups were similar in incidence of variceal rebleeding ( 41.9 % vs. 42.9 % ) , variceal obliteration ( 41.9 % vs. 40.0 % ) , hospital days , blood transfusions , shunt requirements , and survival ( 71.0 % vs. 60.0 % ) . There were significantly more treatment failures for active bleeding using EL ( 42 % vs. 0 % ; P =.027 ) and esophageal stricture formation in the ES-treated patients ( 19.4 % vs. 2.9 % ; P = 0.03 ) . Median total direct cost outcomes were similar between groups ( EL = $ 9,696 and ES = $ 13,197 ; P =.46 ) . EL and ES had similar cost/variceal rebleeding prevented ( $ 28,678 vs. $ 29,093 ) and cost/survival ( $ 27,313 vs. $ 23,804 ) . In the subgroup of active bleeders , ES had a substantially lower cost/survival ( $ 28,523 vs. $ 51,696 ) . We conclude that resource utilization was similar between treatment groups and that the choice of endoscopic therapy for EVH must still rely on clinical grounds . Further studies comparing costs and resource utilization in this patient population are needed .
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Intervention_Surgical
endoscopic sclerotherapy ( ES
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Intervention_Surgical
endoscopic ligation
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Outcome_Other
direct costs of health care utilization and cost-effectiveness
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Outcome_Physical
variceal rebleeding
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Outcome_Physical
variceal obliteration
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Outcome_Other
hospital days , blood transfusions , shunt requirements
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Outcome_Mortality
survival
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Outcome_Physical
active bleeding
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Outcome_Physical
esophageal stricture formation
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Outcome_Other
Median total direct cost
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Outcome_Other
cost/survival
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Participant_Condition
esophageal variceal hemorrhage :
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Participant_Condition
Esophageal variceal hemorrhage ( EVH )