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Cost of Treating An Episode of Variceal Bleeding in A Va Setting

Zaman, Atif, MD1; Arnold, Renée Goldberg J, PharmD2,3,4,5; Pettit, Krista G, PharmD2,3,4,5; Kaniecki, Diana J, PharmD2,3,4,5; Benner, Kent, MD1; Zacker, Christopher, RPh, PhD6; DiCesare, Joseph, RPh, MPH6; Helfand, Mark, MD, MS, MPH7

American Journal of Gastroenterology: May 2000 - Volume 95 - Issue 5 - p 1323–1330
doi: 10.1111/j.1572-0241.2000.02020.x

OBJECTIVES: The specific aims of this study were to develop a demographic description of a sample of patients presenting with bleeding esophageal varices and determine the direct health care costs of variceal bleeding.

METHODS: This was a retrospective evaluation of patients who underwent esophagogastroduodenoscopy at the Portland VA Medical Center between January 1993 and May 1997. Data sources included both electronic databases and patient medical charts. The primary unit of analysis was an episode of care, defined as an index bleed plus 6 months of follow-up or death, whichever came first.

RESULTS: The total inpatient direct cost was $1,566,904 and outpatient direct cost was $104,611, for a total of $1,671,515 for 100 bleeding episodes in 79 patients. Episodes of care for patients receiving ≤2 units of packed red blood cells were approximately a third as costly as those receiving >2 units of packed red blood cells (n = 17, $6,470 and n = 83, $17,553). The difference in costs was statistically significant (p < 0.05), and primarily attributable to hospital bed costs.

CONCLUSIONS: There is a substantial financial burden associated with this illness, primarily attributable to inpatient costs. In addition to severity of bleeding, Child's class, endoscopic findings, and the timing of pharmacological therapy seem to influence the overall cost of managing esophageal varices.

1Department of Gastroenterology, Oregon Health Sciences University, Portland, Oregon, USA

2Pharmacon International, Inc., New York, New York, USA

3Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, New York, USA

4Rutgers College of Pharmacy, Piscataway, New Jersey, USA

5Albany College of Pharmacy, Albany, New York, USA

6Novartis Pharmaceuticals Corp., East Hanover, New Jersey, USA

7Portland Veterans Administration Medical Center, Portland, Oregon, USA

Reprint requests and correspondence: Atif Zaman, MD, Oregon Health Sciences University, Department of Gastroenterology, 3181 S.W. Sam Jackson Park Road, Mail Code PV310, Portland, OR 97201.

Received 08 February 1999; accepted 06 January 2000

© The American College of Gastroenterology 2000. All Rights Reserved.
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