Cost-Effectiveness Analysis of Pharmacotherapy for Hematemesis-Melena Treatment in Hospitalized Patients with Hepatic Cirrhosis

Doddy de Queljoe, Amelia Lorensia, Liana Widharta, Sugiarto Widjaja

Abstract


BACKGROUND: Acute variceal haemorrhage is a complication of cirrhosis that can be life threatening. It is a pharmacist’s duty to ensure therapeutic and pharmaceutical care which is not only safe and effective for the patient but also is cost-effective in order to attain improvement of the patient’s quality of life. Therefore, pharmacoeconomic evaluation especially cost-effectiveness analysis (CEA), which compares costs and consequences of drug therapy, is needed. This study was aimed to evaluate the therapeutic cost-effectiveness of hematemesis-melena treatment in hepatic cirrhotic patients.

METHODS: A total of 42 patients receiving vitamin K and vitamin K-transamin were studied retrospectively from patients’ medical records in 2 years and analyzed with cost-effectiveness grid and average cost-effectiveness ratio (ACER) based on Child-Turcotte-Pugh (CTP) Score.

RESULTS: Cost-effectiveness grid was dominant for vitamin K in patients with CTP Score A. ACER analysis showed a lower score for vitamin K in all patients included CTP Score classification. There was no significant difference in duration of cessation of bleeding treatment in patients with vitamin K compared with vitamin K-transamin in patients with CTP Score A and B, while significant difference was found in patients with CTP Score C.

CONCLUSION: Vitamin K appeared to be more cost effective as compared with vitamin K-transamin in all patients. The use of vitamin K had greater benefit than the combination with transamin in all patients and CTP Score classification, and thus should be considered as a primary therapy. Therefore, transamin addition as an alternative therapy for hepatic cirrhosis patients with hematemesis-melena should be considered.

KEYWORDS: CEA, cost-effectiveness analysis, child-turcotte-pugh score, hepatic cirrhosis, hematemesismelena, vitamin K, transamin


Full Text:

PDF

References


Kenward R, Tan CK. Penggunaan obat pada gangguan hati. In: Aslam M, Tan CK, Prayitno A, editors. Farmasi Klinis-Menuju Pengobatan Rasional dan Penghargaan Pilihan Pasien. Surabaya: Elex Media Komputindo; 2003. p.155-6.

Sease JM, Timm EG, Stragand JJ. Portal hypertension and cirrhosis. In: Dipiro JT, Talbert RL, Yee GC, editors. Pharmacotherapy A Pathophysiologic Approach, 7th ed. Berkshire: McGraw Hill Medical; 2008. p.633-47, NLMID.

Runyon BA. Management of adult patients with ascites due to cirrhosis: An update. American Association for the Study of Liver Diseases. Hepatology. 2009; 50: 1321, CrossRef.

Crawford, James M. The liver, gall bladder, and billiary tract. In: Kumar V, Abbas AK, Fausto N, Mitchell R, editors. Robbins Basic Pathology. 8th ed. Philadelphia: Saunders Elsevier; 2007. p.631-51, NLMID.

National Institute of Health [homepage on the Internet]. Cirrhosis on MedlinePlus [cited 2012]. Available from: https://www.nlm.nih.gov/.

Martin P, Friedman LS. Assessment of liver function and diagnostic studies, In: Friedman LS, Keeffe EB, editors. Handbook of Liver Disease. 2nd ed. Philadelphia: Churchill Livingstone; 2004. p.1-15, NLMID.

Scottish Intercollegiate Guidelines Network (SIGN). Management of acute upper and lower gastrointestinal bleeding - A National ClinicalGuideline. Edinburgh: SIGN; 2008, article.

Sadovsky R. Management of patients with incidental esophageal varices. Am Fam Physician. 2005; 72: 980-5.

Tsao GG, Sanyal AJ, Grace ND, Carey W, the Practice Guidelines Committee of the American Association for the Study of Liver Diseases, the Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. The American Journal of Gastroenterology. 2007; 102: 2086-102, CrossRef.

Vander AJ, Sherman J, Luciano DS. The digestion and absorption of food. In: Vander AJ, Sherman J, Luciano DS, editors. Human Physiology: The Mecanism of Body Function. 8th ed. Philadelphia: The McGraw-Hill Companies; 2001, NLMID.

Biggs JC, Hugh TB, Dodds AJ. Tranexamic acid and upper gastrointestinal haemorrhage - A double-blind trial. Gut. 1976; 17:729-34, CrossRef.

Guerriero C, Cairns J, Perel P, Shakur H, Roberts I. Cost-effectiveness analysis of administering tranexamic acid to bleeding trauma patients using evidence from the CRASH-2 trial. PLoS ONE. 2011; 6: e18987, CrossRef.

Neff GW, Kemmer N, Duncan C, Alsina A. Update on the management of cirrhosis-focus on cost-effective preventative strategies. Clinicoecon Outcomes Res. 2013; 12: 143-52, CrossRef.

UNAIDS. Cost-effectiveness analysis and HIV/AIDS: UNAIDS Technical Update August 1998. [n.p]: UNAIDS; 1998, article.

Sari IP. Penelitian Farmasi Komunitas dan Klinik, Gadjah Mada. Yogyakarta: University Press; 2004.

World Health Organization. Global strategy on diet, physical activity & health: physical activity and adults. Geneva: WHO; 2004, article.

Bootman JL, Townsend RJ, McGhan WF. Introduction to pharmacoeconomics. In: Bootman JL, Townsend RJ, McGhan WF, editors. Principles of Pharmacoeconomics. 3rd ed. Cincinnati: Harvey Whitney Books Company; 2005. p. 1-10, NLMID.

Skrepnek GH. Cost effectiveness analysis (CEA). In: Bootman JL, Townsend RJ, McGhan WF, editors. Principles of Pharmacoeconomics. 3rd ed. Cincinnati: Harvey Whitney Books Company; 2005. p. 83-112, NLMID.

Bootman JL, Harrison DL. Pharmacoeconomics and therapeutic drug monitoring. Pharm World Sci. 1997; 19: 178-81, PMID.

Ponziani FR, Zocco MA, Garcovich M, D'Aversa F, Roccarina D, Gasbarrini A. What we should know about portal vein thrombosis in cirrhotic patients: a changing perspective.World J Gastroenterol. 2012; 28: 5014-20, CrossRef.

Congly SE, Lee SS. Portal vein thrombosis: should anticoagulation be used? Curr Gastroenterol Rep. 2013; 15: 306, CrossRef.

Kumar P, Clark M. Liver, biliary tract and panreatic disease. In: Kumar P, Clark M, editors. Kumar & Clark's Clinical Medicine. 7th ed. London: Saunders Elsevier; 2009. p.219 & 319-20, NLMID.

Pagana KD, Pagana TJ. Blood studies. In: Pagana KD, Pagana TJ, editors. Mosby's Manual of Diagnostic and Laboratory Tests. 3rd ed. St.Louis: Mosby Elsevier; 2006. p.387-445, NLMID.

Durand F, Valla D. Assesment of the prognosis of cirrhosis: Child-pugh versus MELD. J Hepatol. 2005; 42: S100-7, CrossRef.

Ridwan M. Awas! Tiap Tahun 25 Ribu Orang Meninggal Akibat Sirosis Hati. Lensa Indonesia Global Media. 2012.

Franciscus A. Disease Progression: What is Cirrhosis? HCSP version 3.1.2010.

Bickert B, Witmer C. Coagulation disorder. In: Dipiro JT, Talbert RL, Yee GC, editors. Pharmacotherapy A Pathophysiologic Approach. 7th ed. Philadelphia: McGraw Hill Medical; 2008. p. 1665-1682, NLMID.

Sweetman SC. Martindale the Complete Drug Reference. 36th ed. London: Pharmaceutical Press; 2009, NLMID.

McCormick PA, Ooi H, Crosbie O. Tranexamic acid for severe bleeding gastric antral vascular ectasia in cirrhosis. Gut. 1998; 42: 750-2, CrossRef.




DOI: https://doi.org/10.18585/inabj.v5i1.50

Indexed by:

                 

                  

               

     

 

The Prodia Education and Research Institute