Hemostatic powder TC-325 as first-line treatment option for malignant gastrointestinal bleeding: a cost–utility analysis in the United Kingdom
Bibliographic record
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".