Cost-effectiveness analysis of the terlipressin-glycerin trinitrate combination in the pre-hospital management of acute gastro-intestinal haemorrhage in cirrhotic patients

Byline: E. Combier (1), S. Levacher (2), P. Letoumelin (3), A. Joseph (4), J.-L. Pourriat (2), G. de Pouvourville (1) Abstract: Objectives: To assess the cost-effectiveness of an early treatment of upper gastro-intestinal haemorrages in cirrhotic patients. Design: Utilization data linked to the results of a double-blind, placebo-controlled trial demonstrating the efficacy of the terlipressin-glycerin trinitrate combination (TER-GTN) in the reduction of mortality at day 42 for haemorragic patients due to rupture of oesophageal varices. Setting: Hopital Jean Verdier, Bondy, Assistance Publique-Hopitaux de Paris, France. Subjects: Eighty-four patients included over 2 years by emergency services and hospitalized in an intensive care unit (ICU) for haemorrage, 41 in the 'treated' group and 43 in the 'placebo' group. Main outcome measures: Mortality at day 42, cost per death avoided. Results: The mortality rate in the placebo group was 46.5 % versus 27.5 % in the treated group. The mean length of stay was 5 days longer in the treatment group. The excess cost per death avoided was 25,849 FF. Of this extra cost 27 % was due to treatment and 24 % was due to increased length of stay. The excess cost per case treated was FF 5,097, 10 % of the total cost per stay for rupture of oesophageal varices (ROV). Conclusions: Our results are of the same magnitude as those published by Mac Cormick et al. in the United Kingdom for similar treatment. The extra cost appears to be moderate, and much lower than monoclonal antibody therapy for sepsis. The impact on the study hospital budget did not exceed 1.7 10.sup.--4. Author Affiliation: (1) Ecole Nationale de la Sante Publique, Groupe IMAGE-ENSP, 14 rue du Val d'Osne, F-94 410 Saint-Maurice, France e-mail: gdepouvo@ensp.fr Tel. + 3 31 (43) 96 64 18 Fax + 331(43)96 65 29, FR (2) Department of Anaesthesia and Intensive Care, CHU Jean Verdier, F-93140 Bondy, France, FR (3) Service d'Aide Medicale Urgente, SAMU 93, F-93000 Bobigny, France, FR (4) Annie Chicoye Economics, 33 rue Fortuny F-75017 Paris, France, FR Article note: Received: 23 June 1998 Accepted: 18 January 1999