关键词: 食管和胃静脉曲张, 内窥镜检查, 消化系统, 生长抑素, 奥曲肽, 成本及成本分析

Abstract: Objective　To perform a cost-effectiveness analysis of somatostatin versus terlipressin or octreotide in combination with endoscopic variceal ligation（EVL） for esophagogastric variceal bleeding（EVB）．Methods　150 EVB inpatients were enrolled from Jiangxi Pingxiang People's Hospital from January 2009 to July 2017 and were divided into 4 groups by the random number table，EVL group（n=40，undergoing EVL），EVL plus somatostatin group（n=34，undergoing EVL plus somatostatin pump intravenous），EVL plus terlipressin group（n=40，undergoing EVL plus terlipressinintravenous injection） and EVL plus octreotide group（n=36，undergoing EVL plus octreotide pump intravenous）．The hemostasis rate at 24 h，1 week after treatment，length of stay（LOS） after treatment，cost of hospitalization，cost-effectiveness ratio of the treatment regimen，incremental cost-effectiveness（ICE） ratio of the treatment regimen，sensitively analysis of the treatment regimen，incidence of complications and incidence of side effects were compared between the 4 groups.Results　EVL group in particular，demonstrated much lower hemostasis rate compared with other 3 groups（P<0.05）．EVL group in particular，presented much longer LOS compared with other 3 groups（P<0.05）．In terms of cost of hospitalization，EVL plus terlipressin group spent the most of all the groups（P<0.05）．Cost-effectiveness analysis results revealed that EVL group had higher cost-effectiveness ratio than both EVL plus somatostatin and EVL plus octreotide groups（P<0.05）；EVL plus terlipressin group presented the highest cost-effectiveness ratio（P<0.05）．ICE analysis demonstrated that ICE ratio of EVL plus octreotide group was lower than that of EVL plus terlipressin group（P<0.05）．Sensitivity analysis showed the following results：EVL group demonstrated higher cost of hospitalization than EVL plus octreotide group（P<0.05）；EVL plus terlipressin group had the highest cost of hospitalization of all the groups（P<0.05）．EVL group showed higher cost-effectiveness ratio compared with EVL plus somatostatin group and EVL plus octreotide group（P<0.05）；EVL plus terlipressin achieved the highest cost-effectiveness ratio（P<0.05）．ICE ratio of EVL plus octreotide group was lower than that of EVL plus terlipressin group（P<0.05）．There were no significant differences in the incidence of complications as well as the incidence of side effects between the 4 groups（P>0.05）．Conclusion　EVL is an effective treatment for EVB，and the use of it in combination with somatostatin，terlipressin or octreotide can increase the treatment efficacy.Although the 3 combination therapies show similar treatment efficacy，EVL plus terlipressin is the most expensive，followed by EVL plus octreotide，then EVL plus somatostatin.Therefore，EVL plus somatostatin is an ideal regimen for EVB.

Key words: Esophageal and gastric varices, Endoscopy, Digestive system, Somatostatin, Octreotide, Costs and cost analysis