List of publications, posters and presentations

Jalan R, Orme ME, Cheshire LM, van Engen AK. The cost of upper gastrointestinal haemorrhage: A pharmacoeconomic model of the UK variceal haemorrhage guidelines. Presented at BASL AGM, Newcastle, Sept 2002


BACKGROUND AND AIMS: Variceal haemorrhage occurs in about 40% of patients with cirrhosis within 2 years of diagnosis. Despite substantial improvements in management, mortality from an episode of bleeding remains high and treatment of the patient with variceal bleeding is resource intensive. At present, there are no comprehensive data about the healthcare cost of managing a cirrhotic patient who presents with a bleed in the UK. The aim of this pharmacoeconomic study was to develop a decision–analytical model that could be used to evaluate the economic consequences of current practice in the UK from the perspective of the NHS, which would allow assessment of the average treatment costs and cost effectiveness, and to identify the main cost drivers. The model was developed to cover the first 42 days. METHODS: The model was designed to assess healthcare utilisation of a variceal bleed; the treatments used were based on the UK guidelines (Gut 2000;46:Suppl 3:III1–III15); definition of events was based upon the Baveno II criteria; information on possible clinical outcomes were based upon literature review and trial data, and physician interviews (assuming 50% Child class patients, it was estimated that 36% would be free of bleeding, 60% will have initially controlled bleeding and 59% will survive the initial period). Costs were collected from a bottom-up approach—individual items identified and appropriate costs applied (BNF; ‘Unit costs of health and social care’ published by the University of Kent (PSSRU, 2000)). RESULTS: For this period of time, the model estimates that the total cost of treatment is 15 595. 60% of costs are due to hospital admissions, the average length of stay being 14 days. 15% of costs are the cost of disposables, such as blood products. The average cost of a patient with no further bleeding was 42 666; initially controlled bleeding was 25 600; and the average cost of a patient surviving 42 days was 28 468. CONCLUSIONS: The key cost driver is the length of hospital stay and any intervention that leads to earlier discharge and reduces blood product usage would have an impact upon the costs.