Table 4

Deterministic results: TIPSS vs standard care, mean outcomes per person

Cost-utility analysisResource impact: Total discounted costs (£) 2017/2018
CostsQALYsLife yearsICERTIPSS*Variceal bleedingAscitesHESBP+CF
Treatment†Bed daysTreatment†Bed daysTreatment†Bed days
Indication 1: TIPSS for variceal bleeding
Base case results
 TIPSS£61741.0281.720£3383£2230£81£114£52£82£232N/A
 Standard care£67730.8191.354£0£0£4141£2063£113£178£279N/A
 Incremental−£6000.2090.366Dominant£3383£2230−£4059−£1949−£61−£96−£47N/A
Scenario 1: clinical parameters from meta-analysis with Intention-to-treat data for Dunne et al29
 TIPSS£64280.9971.674£3378£2229£96£198£95£149£284NA
 Standard care£59830.8891.465£0£0£3960£1446£147£231£199N/A
 Incremental£4450.1080.209£4128£3378£2229−£3864−£1248−£52−£82£85N/A
Scenario 2: clinical parameters from meta-analysis with per-protocol data for Dunne et al29
 TIPSS£62461.0051.684£3379£2229£81£99£61£97£300N/A
 Standard care£58750.8911.465£0£0£3960£1446£105£165£199N/A
 Incremental£3720.1140.219£3267£3379£2229−£3879−£1347−£43−£68£101N/A
Indication 2: TIPSS for refractory ascites
Base case
 TIPSS£73021.1361.788£3797£1080£34£225£528£1287£349£2
 Standard care£25 2850.6101.158£0£0£93£618£7022£17 117£318£118
 Incremental−£17 9830.5260.630Dominant£3797£1080−£59−£393−£6493−£15 829£31−£116
Scenario 1: reduction LVP procedure frequency
 TIPSS£69731.1361.788£3797£1080£34£225£432£1054£349£2
 Standard care£90260.6101.158£0£0£93£618£2292£5587£318£118
 Incremental−£20530.5260.630Dominant£3797£1080−£59−£393−£1860−£4533£31−£116
  • *Includes costs for all repeat procedures due to shunt dysfunction but excludes TIPSS to treat adverse events. These are included as treatment costs for bleeding and HE.

  • †Treatment costs include all consumables for TIPSS, EBL and LVP, healthcare professional time, diagnostic tests and pharmacotherapy.

  • CF, Catheter Failure; EBL, endoscopic band ligation; HE, hepatic encephalopathy; ICER, incremental cost-effectiveness ratio; LVP, large-volume paracentesis; QALY, quality-adjusted life year; SBP, spontaneous bacterial peritonitis; TIPSS, transjugular intrahepatic stent shunt.