Hauss, JP

Kaps, MD

Schön, MR

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PGI9 FIBRIN-COATED COLLAGEN FLEECE PATCHES OR FIBRIN GLUE? CLINICAL OUTCOMES FOLLOWING LIVER RESECTION SHOW NO DIFFERENCES 

A244 Abstracts
£2460 to £3515 and from £0 to £1050 per hospitalization
averted from NHS and societal perspectives respectively. 
CONCLUSION: This study suggests that a RV vaccination pro-
gramme would have a substantial impact in reducing the impor-
tant burden of RVGE and associated costs in the UK.
PGI9
FIBRIN-COATED COLLAGEN FLEECE PATCHES OR FIBRIN
GLUE? CLINICAL OUTCOMES FOLLOWING LIVER
RESECTION SHOW NO DIFFERENCES
Schön MR, Kaps MD, Hauss JP
University of Leipzig, Leipzig, Germany
OBJECTIVES: Improved dissection techniques and sealing of the
resection surface with ﬁbrin glue are making a signiﬁcant con-
tribution to reduced blood loss in liver surgery. Fibrin glues are
available in the form of ﬁbrin-coated collagen ﬂeece patches that
are altered to suit the resected area, and also as a dual-compo-
nent spray application liquid glue. In this study we compared
both ﬁbrin glues for their differences in efﬁcacy, applicability and
costs. METHODS: In the last two years 200 elective liver resec-
tions were performed. This study focuses on the outcomes for
50 patients on whom either Tachocomb (Nycomed, Unter-
schleißheim) a ﬁbrin-coated collagen ﬂeece patch (Group 1, n =
25), or the spray application of Quixil (Ethicon, Norderstedt) a
ﬁbrin glue (Group 2, n = 25) were used intra-operatively. Demo-
graphic, operative, clinical data and cost were analyzed. In order
to ensure comparability in 2006 the calculation of the cost of the
ﬁbrin products was based on manufacturers currently valid price
lists and did not include discounts or VAT. RESULTS: Differ-
ences in number and weight of resected segments, transfusion
requirements, complications, ICU and hospital stay were not sta-
tistically different between groups. The average quantity of col-
lagen ﬂeece used for Group 1 was 76.6 ± 28.3 cm2. In Group 2,
the average amount of ﬁbrin glue used in the resected area was
2.4 ± 1 ml. A higher average cost for haemostatic agents per
patient was found in Group 1: 583.00 Euros versus 315.56 Euros
in Group 2 (p = 0.014). CONCLUSIONS: No signiﬁcant differ-
ence in the clinical outcome between groups was demonstrated.
Application of liquid ﬁbrin glue has a ﬁnancial advantage over
ﬁbrin-coated collagen ﬂeece patches, bearing in mind the impor-
tant role here of price agreements reached between individual
clinics and manufacturers.
PGI10
COST-EFFECTIVENESS OF ESOMEPRAZOLE VERSUS GENERIC
OMEPRAZOLE IN THE ACUTE TREATMENT OF REFLUX
ESOPHAGITIS IN GERMANY
Wahlqvist P1, Reinhold T2
1AstraZeneca R&D, Mölndal, Sweden, 2Charité University Medical
Center, Berlin, Germany
OBJECTIVES: To assess cost-effectiveness of esomeprazole 
40 mg once daily (od) versus generic omeprazole 20 mg od in 
the acute treatment of reﬂux esophagitis (RE) in Germany.
METHODS: A decision analysis model was used considering
pooled effectiveness data on 8 weeks treatment of RE from three
large, randomised, double-blind comparative clinical studies (n
= 4877). Results were analysed using an 8-week time horizon
and reported separately, including work productivity costs or
direct medical costs (drugs, physician contacts, investigations)
only. Utility values associated with having healed RE (0.84) or
unhealed RE (0.69) were derived from a survey (n = 1011) using
the rating scale method in patients with gastroesophageal reﬂux
disease (GERD). Estimates of GERD-related work productivity
loss (absence from work and reduced productivity while at work)
were derived from observed differences in productivity before
and after treatment with esomeprazole in an open-label clinical
study (n = 237). A probabilistic sensitivity analysis (PSA) on
direct medical costs was used to assess robustness of results,
along with additional analyses extending the time horizon
beyond 8 weeks. An acceptable threshold of €50,000 per quality-
adjusted life year (QALY) gained was used in the PSA. RESULTS:
When including direct medical costs only, the analysis resulted
in mean additional costs of around €13,000 per QALY gained
by using the more effective esomeprazole treatment strategy. The
PSA on the probability of esomeprazole treatment being below
a threshold of €50,000 per QALY gained supported robustness
of a conclusion that esomeprazole treatment is cost-effective
(incremental cost-effectiveness ratio <€50,000 threshold in 90%
of cases). When work productivity costs were included, results
indicated that the esomeprazole strategy is cost-saving. Extend-
ing the time horizon resulted in further cost-effectiveness advan-
tages for esomeprazole. CONCLUSIONS: Esomeprazole 40 mg
od is cost-effective compared with generic omeprazole 20 mg od
in the acute treatment of RE in Germany.
PGI11
ECONOMIC EVALUATION OF THE PHARMACOLOGICAL
THERAPY OF BLEEDING ESOPHAGEAL VARICES IN MEXICO
Garcia-Contreras F1, Constantino-Casas P1, Nevarez-Sida A1,
Del Angel-García G2, García-Constantino M2, Rojas-Martínez E2
1Mexican Institute of Social Security, México, Distrito Federal, Mexico,
2Instituto Mexicano del Seguro Social, México City, Mexico City,
Mexico
OBJECTIVE: To determine the most cost-effective drug in the
treatment of bleeding esophageal varices within the formulary
available in the Mexican Institute of Social Security. METHODS:
Economic evaluation that used costs and quality of life infor-
mation from a multicentric clinical study in Mexican population
and an expert panel. Efﬁcacy data were obtained from a meta-
analysis. The alternatives included were terlipressin and
octreotide. The study perspective was institutional, 5 years time
horizon, 3% real discount rate for both effectiveness and costs.
Costs were estimated from ﬁnancial information from IMSS, and
are reported in US 2006 dollars. A decision tree with a Bayesian
approach, as well as a Markov model with four health states
describing the natural disease course and correction in the middle
of the cycle, were used in the analysis. Mean cost-utility rates,
net economic beneﬁts and net health beneﬁts were calculated.
The sensitivity analysis included threshold, one-way, scenarios
and probabilistic Monte Carlo simulation. RESULTS: Terli-
pressin had the lowest cost per QALY, $119,321 compared with
octreotide, $179,984. The number of QALYs was similar for
both alternatives, with a lower cost per QALY for terlipressin;
therefore, due its being the cheaper one, terlipressin was the
dominant alternative. The expected mean cost per patient in ﬁve
years of octreotide was $83,650, and $66,385 for terlipressin.
Acceptability curves showed that independently of WTP, terli-
pressin had a larger proportion of cost-utility cases in more than
70% and larger net economic and health beneﬁts compared with
octreotide. CONCLUSION: Terlipressin was the option with the
lower cost per QALY in the pharmacological treatment of bleed-
ing esophageal varices. Sensitivity analysis showed that the con-
clusions of the base study were robust.


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PGI9 FIBRIN-COATED COLLAGEN FLEECE PATCHES OR FIBRIN GLUE? CLINICAL OUTCOMES FOLLOWING LIVER RESECTION SHOW NO DIFFERENCES

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