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

摘要： 目的　研究内镜下食管静脉曲张套扎术（EVL）分别联用生长抑素、特利加压素或奥曲肽治疗食管胃底静脉曲张破裂出血（EVB）的经济效果。方法　选择2009年1月—2017年7月萍乡市人民医院收治的EVB住院患者150例为研究对象。根据随机数字表法将患者分为4组：单用内镜下套扎组（n=40，EVL治疗）、内镜下套扎+生长抑素组（n=34，EVL联用生长抑素静脉泵入）、内镜下套扎+特利加压素组（n=40，EVL联用特利加压素静脉注射）、内镜下套扎+奥曲肽组（n=36，EVL联合奥曲肽静脉泵入）。记录4组治疗24 h、1周后止血率，住院天数；比较4组的住院成本、住院成本-效果比及增量住院成本-效果比、敏感度分析结果、并发症发生率和不良反应发生率。结果　单用内镜下套扎组治疗1周后止血率低于其他3组，住院天数长于其他3组（P<0.05）。住院成本、住院成本-效果比及增量住院成本-效果比：单用内镜下套扎组住院成本-效果比高于内镜下套扎+生长抑素组、内镜下套扎+奥曲肽组（P<0.05）；内镜下套扎+特利加压素组住院成本和住院成本-效果比高于其他3组（P<0.05）；内镜下套扎+奥曲肽组增量住院成本-效果比低于内镜下套扎+特利加压素组（P<0.05）。敏感度分析：单用内镜下套扎组住院成本高于内镜下套扎+奥曲肽组（P<0.05）；单用内镜下套扎组住院成本-效果比高于内镜下套扎+生长抑素组、内镜下套扎+奥曲肽组（P<0.05）；内镜下套扎+特利加压素组住院成本、住院成本-效果比高于其他3组（P<0.05）；内镜下套扎+奥曲肽组增量住院成本-效果比低于内镜下套扎+特利加压素组（P<0.05）。4组并发症、不良反应发生率比较，差异无统计学意义（P>0.05）。结论　EVL能有效治疗EVB，EVL联用生长抑素、特利加压素或奥曲肽可提高治疗疗效，且3种联用方案疗效相同。在获得同等疗效的基础上，内镜下套扎+特利加压素组费用最高，内镜下套扎+奥曲肽组费用次之，内镜下套扎+生长抑素组的费用最低，因此内镜下套扎+生长抑素组为最佳治疗方案。

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