Abstract
Current recommendations are that all patients with cirrhosis be screened for varices using upper endoscopy. However, this scope all approach is the most expensive and we need to better define which patients are at risk for variceal bleeding and then screen selectively. There is increasing data that noninvasive tests can predict which patients are most at risk for having varices; however, how this helps with predicting who is going to bleed is less clear. Unfortunately, there are few studies that have examined the cost-effectiveness of these newer tests as compared to upper endoscopy. When these studies have been performed, upper endoscopy is the least cost-effective approach to screening for varices. Using platelet counts or imaging is more cost-effective than is endoscopy and is noninvasive. Comparison of upper endoscopy to elastography on a cost-effectiveness basis needs to be performed to better understand how we should be using these new technologies in the management of the cirrhotic. Guidelines need to contain cost-sensitive recommendations as to screening for varices.
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Boyer, T.D. (2016). Cost Considerations. In: de Franchis, R. (eds) Portal Hypertension VI. Springer, Cham. https://doi.org/10.1007/978-3-319-23018-4_8
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DOI: https://doi.org/10.1007/978-3-319-23018-4_8
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