Based on gaps in knowledge regarding the outcomes of existing strategies for primary and secondary prophylaxis of esophageal varices, several cost-effectiveness analyses have been performed to determine the relative value of these approaches. Conflicts between universal and targeted beta-blocker therapy remain unresolved for primary prophylaxis. The usefulness of HDM for primary prophylaxis is equally unknown. In terms of secondary prophylaxis, the use of combination medical therapy appears cost-effective (especially with HDM). Unfortunately, a great deal of uncertainty remains about the precision of any ICER in the absence of data regarding patient preference and compliance with prescribed strategies. However, the conduct of these studies has served the purpose for highlighting areas of need in terms of further study. Subsequent knowledge, therefore, should be incorporated in revised analyses over time to improve our ability as clinicians to provide maximal health benefits in the setting of appropriate resource use.
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