Presentation (CTI)

OBJECTIVES: Acute variceal bleeding (AVB) is a life-threatening complication of portal hypertension that is associated with substantial morbidity, mortality and health care resource utilization. . Pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) using covered stent technology has been evaluated as an alternative to pharmacological therapy plus endoscopic band ligation (EBL).The objective of this analysis is to evaluate the cost effectiveness of pTIPS using controlled expansion versus pharmacological therapy plus EBL for AVB management in Italy.
METHODS: A health economic model was used to compare pTIPS using controlled expansion with pharmacological therapy plus EBL in patients with AVB over a 2-year time horizon from the Italian health care provider perspective. Clinical and economic outcomes included quality-adjusted life years (QALYs), costs, health care resource utilization and incremental cost-effectiveness ratios (ICERs). Costs were reported in 2025 euros (€). Probabilistic sensitivity analysis (PSA) was conducted to assess model uncertainty.
RESULTS: pTIPS using controlled expansion generated an additional 0.12 QALYs per patient compared with pharmacological therapy plus EBL. The ICER for pTIPS was €18,162 per QALY gained. pTIPS was associated with fewer inpatient ward bed days for management of recurrent bleeding versus pharmacological therapy plus EBL (incremental difference: 3.31 bed days per patient), potentially reducing health care professional utilization. Probabilistic sensitivity analysis demonstrated that pTIPS had a 92.1% probability of being cost effective at a willingness-to-pay threshold of €30,000 per QALY gained.
CONCLUSIONS: In Italy, pTIPS using controlled expansion was associated with increased QALYs compared with pharmacological therapy plus EBL in patients with AVB. pTIPS demonstrated favorable cost effectiveness from the Italian health care provider perspective and was associated with fewer inpatient bed days for recurrent bleeding.