Pharmacoeconomic Evaluation of Terlipressin Versus Noradrenaline in the Treatment of Hepatorenal Syndrome

OBJECTIVE To compare the efficacy and costs of terlipressin and noradrenaline for the treatment of patients with cirrhosis and hepatorenal syndrome(HRS). METHODS Evidence-based medicine method was used to collect randomized-controlled trials for treatment of HRS with terlipressin and noradrenaline. Meta-analysis was performed to obtain the rate of HRS reversal, 30 d survival and adverse events. Economic evaluation was carried out by decision tree model. RESULTS Six randomized-controlled trials(225 patients) were included in the meta-analysis. There was no difference between treatments with terlipressin or noradrenaline in terms of HRS reversal and 30 d survival, had therapeutic equivalence. The rate of adverse reaction were less lower in noradrenaline group compared with terlipressin group. Expected costs of treatment with terlipressin and norepinephrine were 8 085.92 yuan and 890.37 yuan, respectively. Sensitivity analysis showed that the results were stable. CONCLUSION Noradrenaline combined with albumin has a cost-effectiveness superiority in the treatment of liver cirrhosis and HRS. It is recommended that the national health insurance department take the program into full-payout medical insurance and reduce the medical burden of the patients.