title: Using Hemospray Improves the Cost-effectiveness Ratio in the Management of Upper Gastrointestinal Nonvariceal Bleeding.
abstract: OBJECTIVE
  We compared the cost-effectiveness of traditional recommended endoscopic hemostatic therapies and Hemospray alone or in combination when treating nonvariceal upper gastrointestinal bleeding (NVUGIB).
  
  
  BACKGROUND
  Hemospray (TC-325) is a novel endoscopic hemostatic powder, achieving hemostasis through adherence to actively bleeding biological surfaces.
  
  
  METHODS
  A decision tree of patients with NVUGIB assessed 4 possible treatment strategies: traditional therapy alone (T), Hemospray alone (H), traditional therapy completed by Hemospray if needed (T+H), or Hemospray completed by traditional therapy if needed (H+T). Using published probabilities, effectiveness was the likelihood of avoiding rebleeding over 30 days. Costs in 2014 US$ were based on the US National Inpatient Sample. A third-party payer perspective was adopted. Sensitivity and subgroup analyses were performed.
  
  
  RESULTS
  For all patients, T+H was more efficacious (97% avoiding rebleeding) and less expensive (average cost per patient of US$9150) than all other approaches. The second most cost-effective approach was H+T (5.57% less effective and US$635 more per patient). Sensitivity analyses showed T+H followed by a strategy of H+T remained more cost-effective than H or T alone when varying all probability assumptions across plausible ranges. Subgroup analysis showed that the inclusion of H (especially alone) was least adapted for ulcers and was more cost-effective when treating lesions at low risk of delayed rebleeding.
  
  
  CONCLUSIONS
  Hemospray improves the effectiveness of traditional hemostasis, being less costly in most NVUGIB patient populations. A Hemospray first approach is most cost-effective for nonulcer bleeding lesions at low risk of delayed hemorrhage.
authors.affiliation: Division of Gastroenterology.|Clinical Epidemiology, McGill University Health Centre, McGill University, Montréal, Canada.
authors.forename: Alan N
authors.initials: AN
authors.lastname: Barkun
authors.affiliation: Division of Gastroenterology.
authors.forename: Viviane
authors.initials: V
authors.lastname: Adam
authors.affiliation: Division of Gastroenterology.
authors.forename: Yidan
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Division of Gastroenterology.
authors.forename: Yen-I
authors.initials: YI
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology.
authors.forename: Myriam
authors.initials: M
authors.lastname: Martel
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D016558:Hemostasis, Endoscopic / Q000191:economics / Q000706:statistics & numerical data*; D006490:Hemostatics / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008903:Minerals / Q000191:economics / Q000627:therapeutic use*; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy*; D011792:Quebec
chemical_list: D006490:Hemostatics; D008903:Minerals; C581750:hemospray