Objectives: Bleeding Oesophageal Varices (BOV) is a life-threatening condition that affects approximately 50% of cirrhotic patients. Vasoactive agents such as octreotide, vasopressin, somatostatin, and terlipressin are mainstays in the management BOV, with efficacy in attaining hemostasis in about 75% and 67% of patients at 48 hours and at 5 days, respectively. We conducted a cost-effectiveness analysis of terlipressin in the treatment of BOV from the payer’s perspective in the Philippine setting.

Methods: A discrete event simulation was conducted with five health states and six events, representing the spectrum of oesophageal variceal disease and its management. Comparators included octreotide, somatostatin, terlipressin and placebo. Data of efficacy of comparators was obtained from meta-analyses reported in the literature. Natural history of baseline risk, clinical outcomes and health-state utilities were also derived from available published data. The unit cost of health services and their utilization were determined by local cost databases and clinical experts in the Philippines. The analysis adopted a one-year time horizon.

Results: Treatment with the three vasoactive agents were cost-effective with ICERs within the WHO-recommended cost-effectiveness thresholds. Among the three vasoactive drugs, terlipressin was the most cost effective with the lowest ICER when compared to placebo (₱216,555 or approximately 4,336 USD per QALY). One-way deterministic sensitivity analysis showed that our data was robust with ICER results driven by drug costs and length of treatment.

Conclusions: Vasoactive drugs are cost effective in managing BOV. Among the three vasoactive agents studied, terlipressin was the most cost-effective pharmacologic intervention in treating BOV in the Philippines from public payor’s perspective.