Transjugular intrahepatic
portosystemic shunt (
TIPS) and surgical distal
splenorenal shunt (DSRS) are treatments for complications of
portal hypertension.
TIPS is widely used because it is relatively easy to place. Because
TIPS may malfunction over time, it is unclear whether
TIPS is superior to DSRS in patients with Child's class A
cirrhosis who enjoy a longer survival. This study compared the cost-effectiveness of
TIPS to DSRS for
portal hypertension in Child's class A
cirrhosis. A decision analysis model was used to evaluate the number of procedures, life expectancy, and costs over the first 2 years in patients with Child's class A
cirrhosis who underwent a
TIPS or DSRS. Patients who received
TIPS survived 1.96 years, required 1.7 procedures, and incurred $41,685 in costs. Patients who underwent a DSRS survived 1.86 years, required 1.0 procedure, and incurred $26,951 in costs. The cost-effectiveness of
TIPS compared with DSRS was $147,340 per life-year saved. Adjusting the rate of
TIPS dysfunction, 1-year survival, or the number of ultrasounds to detect
TIPS dysfunction did not change the results. In patients with Child's class A
cirrhosis, DSRS is a more cost-effective treatment than
TIPS. Until the results of a randomized controlled trial comparing
TIPS with DSRS are available,
TIPS should be regarded as experimental and prohibitively expensive in Child's class A
cirrhosis.