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CC BY-NC-ND 4.0 · Endoscopy
DOI: 10.1055/a-2495-2813
Original article

Hemospray as first-line treatment option for malignant gastrointestinal bleeding: A cost-utility analysis in the United Kingdom

Dawn Andrew Cooper 
1   HE & Reim, Cook Medical Europe Ltd, Limerick, Ireland (Ringgold ID: RIN36355)
,
Benjamin Norton
2   Digestive Disease and Surgery Institute, Cleveland Clinic London, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN591481)
,
Neil D Hawkes
3   Department of Gastroenterology, Royal Glamorgan Hospital, Llantrisant, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN97692)
,
Srisha Hebbar
4   Gastroenterology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN105646)
,
Andrea Telese
2   Digestive Disease and Surgery Institute, Cleveland Clinic London, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN591481)
,
John Morris
5   Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN59736)
,
Rehan Haidry
6   Digestive Disease and Surgery Institute, Cleveland Clinic London Ltd, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN591481)
,
Alan Barkun
7   Division of Gastroenterology, McGill University Department of Medicine, Montreal, Canada (Ringgold ID: RIN246536)
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Aims: For managing malignant upper gastrointestinal bleeding (MUGIB), randomised control trial data have shown the haemostatic powder; Hemospray (TC-325), results in greater immediate haemostasis and lower 30-day rebleeding rates than standard endoscopic therapy (SET). We sought to determine if using TC-325 as a first-line option for patients with MUGIB would be cost-effective compared with SET in the United Kingdom. Methods: A decision tree was developed among patients with MUGIB, assessing initial therapy with TC-325 or SET over a 30-day time horizon. Patients with failed initial haemostasis, or a rebleed within 30 days, underwent further endoscopic treatment, escalation to either transcatheter arterial embolisation or surgery, or radiotherapy. Overall, 30-day mortality was applied. Costs, in Great British Pounds, were based on the United Kingdom National Health Services costs for 2023/2024. Results are reported as incremental differences in cost, quality-adjusted life years, and net monetary benefit. Deterministic and probabilistic sensitivity analyses and scenario analyses were performed. Results: The cost of treating MUGIB patients with TC-325 was £245.88 lower than SET, with an incremental increase of 0.001 Quality Adjusted Life Years (QALYs). TC-325 remained cost-saving for sensitivity and scenario analyses. Probabilistic sensitivity analysis revealed TC-325 as more effective and cost-saving in 82.0% of simulations (range 68.8-97.8%). Conclusions: Initial treatment of MUGIB with TC-325 compared to SET is more effective (higher primary haemostasis and lower 30-day rebleeding) and cost-saving due to requiring fewer interventions, readmissions, and length of stay. Additional studies are needed to address model uncertainties in the follow-up management of these complex patients.



Publikationsverlauf

Eingereicht: 29. August 2024

Angenommen nach Revision: 28. November 2024

Accepted Manuscript online:
03. Dezember 2024

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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