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

Abstract

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.