Cost-effectiveness of endoscopic ultrasound-guided coils plus cyanoacrylate injection compared to endoscopic cyanoacrylate injection in the management of gastric varices

Table 1 Baseline characteristics and cost description per intervention

	Total (n = 36)	CYA (n = 19)	Coils + CYA (n = 17)	P value
Age (yr), mean ± SD	63.06 ± 10.1	62.83 ± 11.5	63.29 ± 8.8	0.8951
Gender (female), n (%)	16 (44.4)	9 (47.4)	7 (41.2)	0.9702
Indication, n (%)				< 0.0012
Acute bleeding	26 (72.2)	19 (100.0)	7 (41.2)
Secondary prophylaxis	10 (27.7)	-	10 (58.8)
Type of GV, n (%)				0.9062
GOV II	24 (66.7)	12 (63.1)	12 (70.5)
IGV I	12 (33.3)	7 (36.9)	5 (29.5)
Varix size (mm), mean ± SD	21.8 ± 7.8	21.1 ± 8.7	22.6 ± 6.8	0.5781
Technical success (n of events), n (%)	33/36 (91.6)	16/19 (84.2)	17/17 (100)	0.2313
Volume of CYA (mL), median (range)	1.8 (0.6–6.6)	1.8 (0.6–6.6)	1.8 (1.2–2.4)	0.136
No of coils, median (range)	2 (1–3)	0	2 (1–3)	N/A

¹Welch Two Sample t-test.

²Pearson's Chi-squared test with Yates' continuity correction.

³Fisher's Exact Test for Count Data. CYA: Cyanoacrylate; SD: Standard deviation; GV: Gastric varix; GOV: Gastroesophageal varices; IGV: Isolated gastric varices; USD: United States dollar; N/A: Not available.

Table 2 Study outcomes

	Total (n = 36)	CYA (n = 19)	Coils + CYA (n = 17)	P value
Early rebleeding (n of events), n (%)	3/36 (8.3)	3/19 (15.8)	0	0.2311
Adverse events (n of events), n (%)	5/36 (13.8)	3/19 (15.8)	2/17 (11.8)	1.0001
Treatment modality, n (%)				0.0012
Ambulatory	23 (63.1)	7 (36.8)	16 (94.1)
Hospitalization	13 (36.1)	12 (63.2)	1 (5.9)
No of endoscopic procedures, total	45	28	17	N/A
No. of endoscopic procedures per patient, median (range)	1 (1-4)	1 (1-4)	1	0.0143
Length of hospitalization (d), range	0–14	0-14	0–1	< 0.0014
Intensive care unit	0-11	0-11	-	0.0124
Intermediate care unit	0-14	0-14	-	0.0014
Emergency Department	0–1	-	0–1	0.3034
Cost per procedure (USD)	N/A	816.70	2247.00	N/A
Cost per procedure (USD), mean (range)	1696.29 (816.70-3266.80)	1203.56 (816.70-3266.80)	2247.00	< 0.0015
Coil cost (1 coil = $ 300, USD), mean (range)	291.67 (0-900.00)	0	617.65 (300.00-900.00)	< 0.0015
CYA cost (1 vial × 0.3 mL = $ 20.5, USD), mean (range)	130.97.00 (41.00-451.00)	146.74 (41.00-451.00)	113.35 (82.00-164.00)	0.1415
Total procedure cost (USD), mean (range)	2118.93 (857.70-3717.80)	1350.29 (857.70-3717.80)	2978.00 (2629.00-3270.00)	< 0.0015
Hospitalization cost (USD), mean (range)	5158.31 (0-45857.20)	9710.60 (0-45857.20)	70.46 (0-1197.80)	0.0105
Total treatment cost (procedure + hospitalization, USD) mean (range)	7277.20 (919.20-49575.00)	11060.89 (919.20-49575.00)	3007.13 (2629.00-3867.80)	0.0305

¹Fisher's Exact Test for Count Data.

²Pearson's Chi-squared test with Yates' continuity correction.

³Mann–Whitney U test.

⁴Gray’s test.

⁵Welch Two Sample t-test. CYA: Cyanoacrylate; SD: Standard deviation; GV: Gastric varix; GOV: Gastroesophageal varices; IGV: Isolated gastric varices, USD: United States dollar; N/A: Not available.

Table 3 Incremental Cost Effectiveness Ratio analysis

Efficacy outcome	ICER analysis
Early rebleeding (n of events)	(USD 3048.50) - (USD 11060.90)/(0) - (3) = US$ 2670.80
Adverse events (n of events)	(USD 3048.50) - (USD 11060.90)/(2) - (3) = US$ 8012.40
Length of hospitalization (total days)	(USD 3048.50) - (USD 11060.90)/(1) - (64) = US$ 127.18
6-mo mortality (n of events)	(USD 3048.50) - (USD 11060.90)/(0) - (1) = US$ 8012.40

ICER: Incremental Cost-Effectiveness Ratio; USD: United States of America dollar.