Presentation (CTI)

OBJECTIVES: This study aimed to evaluate the cost and clinical consequences of TIPS compared to repeated LVP in patients with refractory ascites, from the perspective of the Italian National Health Care Service. The objective was to determine whether TIPS offers cost savings through reduced hospitalisations, complications and healthcare utilisation.
METHODS: A preliminary Italian cost-consequence model was adapted from a previously published Spanish Markov-based cost-effectiveness analysis. The model compared all healthcare resources associated with initial implantation, repeat procedures, diagnostics, complications and follow-up care between TIPS and LVP. Unit costs were derived from regional tariffs and literature, and all costs were analysed in euros. The analysis assumed a two-year time horizon and accounted for both procedure-related and long-term consequences.
RESULTS: The total cost per patient for TIPS was €8,829, compared to €28,122 for LVP, at two years, resulting in an incremental saving of €19,293 in favour of TIPS. LVP incurred substantially greater costs due to frequent paracentesis procedures (€5,843) needed, healthcare professionals (€618), consumables (€8,797), hospital stays (€12,110), complications and spontaneous bacterial peritonitis (€147). Additionally, TIPS was associated with reduced healthcare professional involvement and minimised reintervention rates.
CONCLUSIONS: Despite higher initial costs, TIPS can be a cost-saving alternative to repeated LVP treatments in managing refractory ascites within the Italian healthcare setting. The potential reduction in complications, inpatient stays and resource utilisation highlights the value of TIPS from both an economic and clinical standpoint, supporting its broader adoption in eligible patient populations.