Cost-utility analysis of using the haemostatic powder TC-325 as a first-line treatment for malignant upper gastrointestinal bleeds in the United Kingdom
Notice bibliographique
Résumé
Aims Haemostatic powder TC-325 is a valuable option for the management of malignant upper gastrointestinal bleeding (MUGIB). Randomised control trial (RCT) data has shown it results in greater immediate haemostasis and lower 30-day rebleeding rates when compared to standard endoscopic therapy (SET). Initial purchase cost for TC-325 can be higher compared with standard endoscopic treatments. We sought to determine if the use of haemostatic powder TC-325 would be cost-effective as a first-line option for MUGIB compared with SET in the United Kingdom. Methods We developed a decision tree among patients with MUGIB that assessed initial therapy with TC-325 compared to SET to enable a cost-utility analysis. The model was parameterised using published data including a recent RCT to inform initial haemostatic success, rates of rebleed, and quality of life data. Patients with failed initial haemostasis after SET underwent either rescue with TC-325, escalation to interventional radiological embolisation (IRE), or surgery. Initial failure in the primary TC-325 group was followed by use of a second TC-325 canister, IRE, or surgery. The decision tree included a possibility of one rebleed within 30 days following which patients would be treated with repeat endoscopy (matching the treatment arm i.e. no crossover at rebleed), IRE, surgery, or radiotherapy (when other treatment options are not suitable). Overall, 30-day mortality was applied. Results are reported as incremental differences in cost (Great Britain, Pounds) and quality-adjusted life years (QALYs). Scenario analyses were explored and deterministic and probabilistic sensitivity analyses were performed on all costs, transition probabilities and utilities. Results The total costs of using TC-325 for the treatment of MUGIB was £322 lower than SET over the 30 days, and an incremental increase of 0.012 QALYs. One-way deterministic sensitivity revealed the model was most sensitive to changes in rebleeding rate for SET. However, TC-325 remained cost-saving for all parameter changes. Probabilistic sensitivity analysis revealed that TC-325 has a 92% probability of being cost-saving. Conclusions This model indicates that through higher primary haemostasis and lower 30-day rebleeding, TC-325 could be a cost-effective treatment for MUGIB by reducing costly downstream repeat interventions. Despite a complex and nuanced pathway for the treatment of MUGIB, we have shown we can formally model the cost-effectiveness of haemostatic powder TC-325. Uncertainty in this model exists due to limited detail on follow-up actions after haemostatic failure (primary and rebleed), and the occurrence of multiple rebleeds that we could not include in the model. Additional large-scale randomised studies, with detailed treatment follow-up would help inform a more comprehensive model. [ 1 ] Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,024 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,003 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».