Hostname: page-component-cb9f654ff-w5vf4 Total loading time: 0 Render date: 2025-09-02T00:07:53.441Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-Effectiveness Analysis of Treatment for Esophageal Varices in Japan

Published online by Cambridge University Press:  10 March 2009

Akira Sasaki  and
John M. Eisenberg
Akira Sasaki
Affiliation:
Iwakuni National Hospital, Japan
John M. Eisenberg
Affiliation:
University of Pennsylvania School of Medicine
Get access Rights & Permissions [Opens in a new window]

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.

Information

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 3 , Issue 4 , October 1987 , pp. 575 - 586
Copyright
Copyright © Cambridge University Press 1987

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

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.CrossRefGoogle ScholarPubMed
2.Arakawa, T., & Yamamoto, S.Cost of treatment for cirrhotic portal hypertension [Abstract]. Japanese Journal of Gastroenterology, 1985, 82 (suppl.), 871 (in Japanese).Google Scholar
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.CrossRefGoogle ScholarPubMed
4.Chung, R., & Lewis, J. W.Cost of treatment of bleeding esophageal varices. Archives of Surgery, 1983, 118, 482–85.CrossRefGoogle ScholarPubMed
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).Google Scholar
6.Idezuki, Y. et al. , Treatment of esphageal varices: A historical review. Stomach and Intestine, 1985, 20, 469–79 (in Japanese with English abstract).Google Scholar
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, 61–65.CrossRefGoogle Scholar
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, 71–83 (in Japanese).Google Scholar
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.CrossRefGoogle Scholar
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.Google Scholar
11.Japanese Research Society for Portal Hypertension. The general rules for recording endoscopie findings on esophageal varices. Japanese Journal of Surgery, 1980, 10, 84–87.Google Scholar
12.Kinoshita, E., & Sugiura, M.Cost-effectiveness analysis for treatment of esophageal varices [Abstract]. Japanese Journal of Gastroenterology, 1985, 82 (suppl.), 871 (in Japanese).Google Scholar
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).Google Scholar
14.Kobayashi, M.Present status and perspectives of surgical treatment for esophageal varices. Gekachiryo, 1982, 47, 323–30 (in Japanese).Google Scholar
15.Kobayashi, M.Present status and perspective of treatment of esophageal varices. Gekachiryo, 1985, 53, 21–32 (in Japanese).Google Scholar
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).Google Scholar
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, 693–701.Google ScholarPubMed
18.Paquet, J. J.Prophylactic endoscopic sclerosing treatment of the esophageal wall in varices: A prospective controlled randomized trial. Endoscopy, 1982, 14, 4–5.CrossRefGoogle ScholarPubMed
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).Google Scholar
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.CrossRefGoogle ScholarPubMed
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).Google Scholar
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.Google ScholarPubMed
23.Terblanche, J.The long-term management of patients after an oesophageal variceal bleed: The role of sclerotherapy. British Journal of Surgery, 1985, 72, 88–90.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
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, 1594–1600.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
27.Weinstein, M. C., Feinberg, H. V. et al. , Clinical decision analysis: Probabilities and clinical decisions. Philadelphia: W.B. Saunders, 1980, 37–74.Google Scholar
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.CrossRefGoogle ScholarPubMed
29.Witzel, L., Wolbergs, E., & Merki, H.Prophylactic endoscopic sclerotherapy of esophageal varices: A prospective controlled study. Lancet, 1985, I, 773–75.CrossRefGoogle Scholar