Performance of screening strategies for primary prophylaxis of variceal bleeding in patients with compensated cirrhosis: a cost-effectiveness analysis

Background and aims: Screening tools including esophagogastroduodenoscopy (EGD) and non-invasive methods (Baveno VI criteria) have been recommended to be performed in clinical practice in order to identify the high-risk patients and prevent the first episode of variceal bleeding in compensated cirrhosis. In this study, we aimed to examine the cost-effectiveness of screening tools, and to provide evidence-based information for decision and policy making.
Method: We developed an analytic decision model in which Markov models were embedded. Clinical parameters were derived from published literature and meta-analysis. Meanwhile, medical costs were collected in Chinese yuan from multi-level hospitals in China and converted into US dollars at an exchange rate of 6.53 yuan per dollar. Deterministic and probabilistic sensitivity analyses are followed. Our model was calculated over a five-year horizon.
Results: Patients categorized in the no screening scenario faced both the highest total cost of $1421 per patient and the lowest life expectancy of 4.74 years per patient, and therefore the no screening strategy was dominated and excluded. Screening with Baveno VI criteria had the cheapest medical cost of $1022 per patient, and ...