Neff Guy W, Kemmer Nyingi, Duncan Christopher, Alsina Angel
Tampa General Medical Group, Tampa, FL.
Clinicoecon Outcomes Res. 2013 Apr 12;5:143-52. doi: 10.2147/CEOR.S30675. Print 2013.
Cirrhosis is a chronic liver disease stage that encompasses a variety of etiologies resulting in liver damage. This damage may induce secondary complications such as portal hypertension, esophageal variceal bleeding, spontaneous bacterial peritonitis, and hepatic encephalopathy. Screening for and management of these complications incurs substantial health care costs; thus, determining the most economical and beneficial treatment strategies is essential. This article reviews the economic impact of a variety of prophylactic and treatment regimens employed for cirrhosis-related complications. Prophylactic use of β-adrenergic blockers for portal hypertension and variceal bleeding appears to be cost-effective, but the most economical regimen for treatment of initial bleeding is unclear given that cost comparisons of pharmacologic and surgical regimens are lacking. In contrast, prophylaxis for spontaneous bacterial peritonitis cannot be recommended. Standard therapy for spontaneous bacterial peritonitis includes antibiotics, and the overall economic impact of these medications depends largely on their direct cost. However, the potential development of bacterial antibiotic resistance and resulting clinical failure should also be considered. Nonabsorbable disaccharides are standard therapies for hepatic encephalopathy; however, given their questionable efficacy, the nonsystemic antibiotic rifaximin may be a more cost-effective, long-term treatment for hepatic encephalopathy, despite its increased direct cost, because of its demonstrated efficacy and prevention of hospitalization. Further studies evaluating the cost burden of cirrhosis and cirrhosis-related complications, including screening costs, the cost of treatment and maintenance therapy, conveyance to liver transplantation, liver transplantation success, and health-related quality of life after transplantation, are essential for evaluation of the economic burden of hepatic encephalopathy and all cirrhosis-related complications.
肝硬化是一种慢性肝病阶段，涵盖多种导致肝损伤的病因。这种损伤可能引发继发性并发症，如门静脉高压、食管静脉曲张破裂出血、自发性细菌性腹膜炎和肝性脑病。对这些并发症的筛查和管理会产生高昂的医疗费用；因此，确定最经济有效的治疗策略至关重要。本文综述了用于肝硬化相关并发症的各种预防和治疗方案的经济影响。预防性使用β-肾上腺素能阻滞剂治疗门静脉高压和静脉曲张破裂出血似乎具有成本效益，但鉴于缺乏药物和手术方案的成本比较，初始出血治疗的最经济方案尚不清楚。相比之下，不推荐对自发性细菌性腹膜炎进行预防。自发性细菌性腹膜炎的标准治疗包括使用抗生素，这些药物的总体经济影响在很大程度上取决于其直接成本。然而，还应考虑细菌抗生素耐药性的潜在发展及其导致的临床治疗失败。不可吸收的二糖是肝性脑病的标准治疗方法；然而，鉴于其疗效存疑，非全身性抗生素利福昔明可能是一种更具成本效益的肝性脑病长期治疗方法，尽管其直接成本增加，但其已证实的疗效和预防住院的作用使其具有优势。进一步评估肝硬化及肝硬化相关并发症成本负担的研究，包括筛查成本、治疗和维持治疗成本、肝移植转运、肝移植成功率以及移植后与健康相关的生活质量等，对于评估肝性脑病及所有肝硬化相关并发症的经济负担至关重要。
