Vasoconstrictors in the Management of Bleeding from Oesophageal Varices a Clinico-Economic Appraisal in the UK

Abstract

Background: Bleeding from oesophageal varices is an uncommon but potentially fatal condition that often leads to expensive hospitalizations in intensive care or high-dependency units. Methods: To assess the clinical and economic impact of this condition, we have devised a management plan illustrating current clinical practice in the UK. Results: Approximately £6.1 million of NHS resources are devoted to the treatment of 3000 acute hospital admissions for variceal bleeding every year. Vasoconstrictors like vasopressin may save approximately 36 lives per annum for an additional £145 thousand. However, current clinical practice requires vasopressin to be concurrently administered with intravenous glyceryl trinitrate, increasing overall costs by £582 thousand to a total of £6.7 million. The additional cost for each extra life saved is estimated at £16,180. Conclusion: The efficacy of current vasoconstrictors requires further confirmation. In particular, new agents like octreotide (Sandostatin®) should be carefully assessed to determine their potential clinical and economic benefits.

Key Words:

• Cost analysis
• haemorrhage
• nitroglycerin
• oesophageal and gastric varices
• vasoconstrictor agents
• vasopressins