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World J Gastroenterol. Aug 14, 2014; 20(30): 10464-10469
Published online Aug 14, 2014. doi: 10.3748/wjg.v20.i30.10464
Published online Aug 14, 2014. doi: 10.3748/wjg.v20.i30.10464
Cost-effectiveness analysis of beta-blockers vs endoscopic surveillance in patients with cirrhosis and small varices
Lorenza Di Pascoli, Massimo Bolognesi, Sara Montagnese, Angelo Gatta, Carlo Merkel, Hepatic Hemodynamic Laboratory and Clinica Medica 5, Department of Medicine, University of Padua, 35128 Padova, Italy
Alessandra Buja, Dario Gregori, Laboratory of Epidemiological Methodology and Biostatistics, Department of Environmental Medicine and Public Health, University of Padua, 35128 Padova, Italy
Author contributions: Di Pascoli L coordinated the work and participated in the analysis and writing of the manuscript; Buja A and Gregori D performed the cost-effective analysis; Bolognesi M, Montagnese S and Gatta A performed the follow up of the patients and controlled the adeguacy of the data set; Merkel C conceived the study, participated in the analysis and revised the manuscript.
Correspondence to: Carlo Merkel, MD, Hepatic Hemodynamic Laboratory and Clinica Medica 5, Department of Medicine, University of Padua, via Giustiniani 2, 35128 Padova, Italy. carlo.merkel@unipd.it
Telephone: +39-49-8212282 Fax: +39-49-8754179
Received: December 15, 2013
Revised: February 9, 2014
Accepted: April 30, 2014
Published online: August 14, 2014
Revised: February 9, 2014
Accepted: April 30, 2014
Published online: August 14, 2014
Core Tip
Core tip: In patients with cirrhosis and small esophageal varices no study so far has evaluated the economical consequences of replacing traditional endoscopic surveillance with primary prophylaxis with beta-blockers from this stage. In this study, a decision analysis based on stochastic regression trees and Markov models compared cost-effectiveness of primary prophylaxis with beta-blockers (starting from the diagnosis of small varices) and endoscopic surveillance (and beta-blockers administration when large varices develop). Beta-blocker therapy from the beginning turned out to be more effective and less expensive. This result demonstrate that an early beta-blocker therapy besides being clinically effective, is also also cost-effective.