UPPER gastrointestinal endoscopy (EGD) is traditionally the gold standard for diagnosing high-risk varices (HRV) in patients with cirrhosis. However, the Baveno VI criteria, which combine liver stiffness measurement via transient elastography and platelet count, offer a noninvasive alternative to rule out HRV and potentially reduce the need for costly and invasive endoscopies.
A cost-effectiveness analysis compared the Baveno VI criteria with EGD for detecting HRV in patients with Child-Pugh A cirrhosis. The study used a Markov model, drawing data from the UK National Health Service (NHS) and additional data from Canada and Spain. Quality-adjusted life years (QALYs) and cost were the primary measures used to assess the benefits.
The analysis demonstrated that the Baveno VI criteria are a cost-effective option in comparison to routine EGD. Over five years, the criteria generated an incremental 0.16 QALYs per patient at an additional cost of £326, resulting in an incremental cost-effectiveness ratio (ICER) of £2081 per QALY, significantly below the accepted cost threshold of £20,000–30,000 per QALY. Across all three countries, the criteria provided both economic savings and clinical benefits, avoiding unnecessary endoscopies while safely managing patients with cirrhosis.
The expanded Baveno VI criteria, which include a more flexible platelet and liver stiffness cut-off, could avoid even more endoscopies without significantly increasing the risk of missing HRV. The use of noninvasive methods offers substantial healthcare system efficiencies, reducing the burden on endoscopy services, particularly during the COVID-19 pandemic when procedures were restricted.
While the criteria are highly specific and reduce unnecessary procedures, sparing endoscopies may occasionally miss oesophagal or gastric cancers. Nonetheless, the overall benefits, both economic and clinical, support the widespread adoption of the Baveno VI criteria in managing patients with compensated cirrhosis.
Katie Wright, EMJ
Reference
Pizzo E et al. Cost-effectiveness of the Baveno VI criteria compared with endoscopy for high-risk varices in patients with child-pugh a cirrhosis. Clin Gastroenterol Hepatol. 2024;22(10):2053-61.
