An economic evaluation of vasoactive agents used to treat acute bleeding oesophageal varices in Belgium

Background and study aims : Increasingly, cost influences all areas of healthcare, including the management of life threatening events, such as bleeding oesophageal varices (BOV). In light of the need to control costs, an economic evaluation of vasoactive agents used to treat cirrhotic patients with BOV within the emergency set- ting in Belgium has been assessed. Patients and methods : A previously reported economic evalua- tion of vasoactive agents used to treat BOV was identified and adapted to the Belgium hospital setting. The economic evaluation was based on double-blind randomised controlled trials of vasoac- tive agents previously reported as Cochrane meta-analyses. Belgian cost data was obtained from local published sources and hospital databases. We assessed average disaggregated and aggre- gated treatment costs, average and incremental cost per quality adjusted life years (QALYs) and life-years gained (LYG). Results: Total treatment costs at 1 year were: terlipressin € 2,734 ; somatostatine € 2,972 ; octreotide € 2,801 ; and placebo € 2,874. The average costs per QALY were : terlipressin € 4,672 ; somatostatine € 5,878 ; octreotide € 5,540 ; and placebo € 5,687. In the cost per LYG analysis terlipressin achieved the lowest cost per life-year. Results from the incremental cost per QALY and LYG analysis indicated that terlipressin was the most cost-effective agent. Conclusions : One year simulations indicate somatostatine is the most expensive treatment option and terlipressin the least costly. Amongst the vasoactive products, the incremental analysis indicat- ed terlipressin was dominant when compared with octreotide and somatostatine because of improved survival and cost-saving poten- tial that is likely attributed to avoiding additional and more costly interventions. (Acta gastroenterol. belg., 2008, 71, 230-236).