Skip to main content Accessibility help
×
Home

Cost-Effectiveness Analysis of Treatment for Esophageal Varices in Japan

  • Akira Sasaki (a1) and John M. Eisenberg (a2)

Abstract

We analyzed the cost-effectiveness of nonemergent treatment for esophageal varices commonly used in Japan (endoscopic injection sclerotherapy, nonshunting direct interruption procedure, and selective shunt). We assessed the cost per survivor from the perspective of the Japanese government and other payors. Epidemiologic and economic data from published Japanese literature and from Japanese hospital-cost information were applied in decision analysis. While sclerotherapy is the most cost-effective treatment, the popular surgical procedures save the most lives, thus raising difficult ethical issues regarding trade-offs of cost and quality.

Copyright

References

Hide All
1.Allison, J. G.The role of injection sclerotherapy in the emergency and definitive management of bleeding esophageal varices. Journal of the American Medical Association, 1983, 249, 1484–87.
2.Arakawa, T., & Yamamoto, S.Cost of treatment for cirrhotic portal hypertension [Abstract]. Japanese Journal of Gastroenterology, 1985, 82 (suppl.), 871 (in Japanese).
3.Cello, J. P., Grendell, J. H., Crass, R. A. et al. , Endoscopie sclerotherapy versus portacaval shunt in patients with severe cirrhosis and variceal hemorrhage. New England Journal of Medicine, 1984, 311, 1589–94.
4.Chung, R., & Lewis, J. W.Cost of treatment of bleeding esophageal varices. Archives of Surgery, 1983, 118, 482–85.
5.Health Insurance Bureau of the Ministry of Health and Welfare. Survey and report about National Health Insurance, Japan, 1983. Tokyo, Ministry or Health and Welfare, 1985 (in Japanese).
6.Idezuki, Y. et al. , Treatment of esphageal varices: A historical review. Stomach and Intestine, 1985, 20, 469–79 (in Japanese with English abstract).
7.Inokuchi, K.Cooperative study group of portal hypertension of Japan. Prophylactic portal nondecompression surgery in patients with esophageal varices. Annals of Surgery, 1984, 200, 6165.
8.Inokuchi, K., & Beppu, K. High likelihood of bleeding from esophageal varices. In Mito, M. and Takino, T. (eds.), Liver cirrhosis and liver tumor: Practical approach to their multidisciplinary diagnosis and treatment. Tokyo: Igaku Shoin Ltd., 1984, 7183 (in Japanese).
9.Inokuchi, K., Beppu, K., Koyanagi, N. et al. , Fifteen years' experience with left gastric venous cavai shunt for esophageal varices. World Journal of Surgery, 1984, 8, 716–21.
10.Inokuchi, K., Kobayashi, M., Ogawa, Y. et al. , Results of left gastric vena cavai shunt for esophageal varices: Analysis of one hundred clinical cases. Surgery, 1975, 78, 628–36.
11.Japanese Research Society for Portal Hypertension. The general rules for recording endoscopie findings on esophageal varices. Japanese Journal of Surgery, 1980, 10, 8487.
12.Kinoshita, E., & Sugiura, M.Cost-effectiveness analysis for treatment of esophageal varices [Abstract]. Japanese Journal of Gastroenterology, 1985, 82 (suppl.), 871 (in Japanese).
13.Kitano, S., & Inokuchi, K.Cost of treatment of esophageal varices: Comparison between selective shunts and injection sclerotherapy [Abstract]. Japanese Journal of Gastroenterology, 1985, 82 (suppl.), 872 (in Japanese).
14.Kobayashi, M.Present status and perspectives of surgical treatment for esophageal varices. Gekachiryo, 1982, 47, 323–30 (in Japanese).
15.Kobayashi, M.Present status and perspective of treatment of esophageal varices. Gekachiryo, 1985, 53, 2132 (in Japanese).
16.Mito, M., & Asakawa, Z. Cost-effective analysis of medical and surgical therapy for esophageal varices. In Mito, M. and Takino, T. (eds.), Liver cirrhosis and liver tumor: Practical approach to their multidisciplinary diagnosis and treatment. Tokyo: Igaku Shoin Ltd., 1984, 148–56 (in Japanese).
17.O'Donnell, T. F., Gembarowicz, R. M., Callow, A. D. et al. , The economic impact of acute variceal bleeding: Cost-effectiveness implications for medical and surgical therapy. Surgery, 1980, 88, 693701.
18.Paquet, J. J.Prophylactic endoscopic sclerosing treatment of the esophageal wall in varices: A prospective controlled randomized trial. Endoscopy, 1982, 14, 45.
19.Statistics and Information Department of the Ministry of Health and Welfare. Survey and report about Government-managed Health Insurance: Japan, 1983. Tokyo: Health and Welfare Statistics Association, 1985 (in Japanese).
20.Sugiura, M., Futagawa, S.Esophageal transection with paraesophagogastric devas-cularizations (the Sugiura procedure) in the treatment of esophageal varices. World Journal of Surgery, 1984, 8, 673–82.
21.Takase, Y., Kobayashi, Y., Chikamori, F. et al. , Endoscopie sclerotherapy for esophageal varices: its practice and prognosis. Stomach and Intestine, 1985, 20, 481–87 (in Japanese with English abstract).
22.Takase, Y., Ozaki, A., Orii, K. et al. , Injection sclerotherapy of esophageal varices for patients undergoing emergency and elective surgery. Surgery, 1982, 474–79.
23.Terblanche, J.The long-term management of patients after an oesophageal variceal bleed: The role of sclerotherapy. British Journal of Surgery, 1985, 72, 8890.
24.Terblanche, J., Bornman, P. C, Kahn, D. et al. , Failure of repeated injection sclerotherapy to improve long-term survival after esophageal variceal bleeding: A five-year prospective controlled clinical trial. Lancet, 1983, II, 1328–32.
25.The Copenhagen Esophageal Varices Sclerotherapy Project. Sclerotherapy after first variceal hemorrhage in cirrhosis: A randomized multicenter trial. New England Journal of Medicine, 1984, 311, 15941600.
26.Warren, W. D., Zeppa, R., Fomon, J. J.Selective trans-splenic decompression of gastroesophageal varices by distal splenorenal shunt. Annals of Surgery, 1967, 166, 437–55.
27.Weinstein, M. C., Feinberg, H. V. et al. , Clinical decision analysis: Probabilities and clinical decisions. Philadelphia: W.B. Saunders, 1980, 3774.
28.Westaby, D., Macdougall, B. R. D., & Williams, R.Improved survival following injection sclerotherapy for esophageal varices: Final analysis of a controlled trial. Hepatology, 1985, 5, 827–30.
29.Witzel, L., Wolbergs, E., & Merki, H.Prophylactic endoscopic sclerotherapy of esophageal varices: A prospective controlled study. Lancet, 1985, I, 773–75.

Cost-Effectiveness Analysis of Treatment for Esophageal Varices in Japan

  • Akira Sasaki (a1) and John M. Eisenberg (a2)

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed