Which Is More Cost-Effective for Primary Prevention of Variceal Hemorrhage: β-Blockers or Banding?

Primary prevention of variceal hemorrhage (VH) is indicated in cirrhotic patients, because VH is associated with substantial morbidity and mortality. Currently, nearly all cirrhotic patients should undergo upper endoscopy to identify large varices. β-blocker therapy reduces the incidence of VH by 50% in patients with large varices; however, β-blocker use is limited by its side effects and its inability to achieve consistent reduction in the portal pressure gradient. Endoscopic band ligation (EBL) is at least equivalent to β-blocker therapy for preventing first variceal hemorrhages but is more expensive. In this decision analysis, investigators identified the conditions under which EBL would be cost-effective.

Markov modeling was used to eval…