Cost-utility analysis of using the haemostatic powder TC-325 as a first-line treatment for malignant upper gastrointestinal bleeds in the United Kingdom
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.024 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".