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CC BY-NC-ND 4.0 · Endoscopy 2025; 57(06): 583-592
DOI: 10.1055/a-2495-2813
Original article

Hemostatic powder TC-325 as first-line treatment option for malignant gastrointestinal bleeding: a cost–utility analysis in the United Kingdom

Dawn M. Cooper 
1   Cook Medical (UK), Altrincham, United Kingdom of Great Britain and Northern Ireland
,
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
,
Srisha Hebbar
4   Department of 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   Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN59736)
,
Rehan Haidry
2   Digestive Disease and Surgery Institute, Cleveland Clinic London, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN591481)
,
Alan Barkun
6   Division of Gastroenterology, Department of Medicine, McGill University, Montreal, Canada
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Referred to by:

Author commentary on Dawn M. Cooper et al.Endoscopy 2025; 57(06): v18-v18
DOI: 10.1055/a-2508-0024

Abstract

Background

Randomized controlled trials have shown that hemostatic powder (TC-325) results in greater immediate hemostasis and lower 30-day rebleeding rates than standard endoscopic therapy (SET) for management of malignant upper gastrointestinal bleeding (MUGIB). We explored whether TC-325 would be a cost-effective first-line option for patients with MUGIB compared with SET in the United Kingdom.

Methods

A decision tree was developed for patients with MUGIB, assessing initial therapy with TC-325 or SET over a 30-day period. Patients with failed initial hemostasis or a rebleed within 30 days underwent further endoscopic treatment, escalation to either transcatheter arterial embolization or surgery, or radiotherapy. Overall 30-day mortality was applied. Costs, in GBP, were based on the United Kingdom National Health Services costs for 2023/2024. Results were reported as incremental differences in cost, quality-adjusted life years (QALY), 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 treatment with SET, with an incremental increase of 0.001 QALYs. TC-325 remained a cost-saving approach in sensitivity and scenario analyses. Probabilistic sensitivity analysis revealed that TC-325 was more effective and cost saving in 80.1% of simulations (range 67.5%–98.63%).

Conclusions

Initial treatment of MUGIB with TC-325 compared with SET was more effective (higher primary hemostasis and lower 30-day rebleeding) and cost saving owing to the requirement for fewer interventions, readmissions, and length of stay. Additional studies are needed to address model uncertainties in the follow-up management of these complex patients.

Supplementary Material



Publication History

Received: 29 August 2024

Accepted after revision: 28 November 2024

Accepted Manuscript online:
03 December 2024

Article published online:
15 January 2025

© 2025. 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/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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