Endoscopic Management for Non-Variceal Upper Gastrointestinal Bleeding: A Network Meta-Analysis of Randomized Controlled Trials and Cost-Effectiveness Analyses of 2 Health Care Systems.
Noppachai Siranart, Yanisa Chumpangern, Patavee Pajareya et al.
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In 30 seconds
This network meta-analysis of randomized controlled trials compared over-the-scope clips (OTSC), hemostatic powder (HP), and standard endoscopic therapy (ST) for non-variceal upper gastrointestinal bleeding. Ten trials involving 1,120 patients contributed to the analysis. OTSC had the highest probability of ranking best for 30-day rebleeding (P-score 0.996) and further bleeding (0.906). Cost-effectiveness models across US and Thai health care settings found OTSC dominant over ST and, in the US, over HP; in Thailand, it was more cost-effective than HP.
Key findings
- For 30-day rebleeding, OTSC ranked highest (P-score: 0.996), followed by ST (0.296) and HP (0.208).
- For 30-day further bleeding, OTSC ranked highest (0.906), followed by HP (0.570) and ST (0.024).
- In the US model, OTSC was dominant over HP (ICER: -$314) and ST (-$3,112).
- In Thai models, OTSC dominated ST and was more cost-effective than HP, with ICERs of THB 1,833 and THB 2,026 for HP comparisons.
Why it matters
The analysis brings comparative efficacy and economic modelling together for endoscopic hemostasis in NVGIB. Its findings suggest OTSC may reduce short-term bleeding outcomes while offering favourable modeled value across the health care settings assessed. The results can inform evaluation of endoscopic options, while recognizing that cost-effectiveness depends on the modeled setting and assumptions.
What to keep in mind
Cost-effectiveness estimates came from Markov models with a 12-month time horizon and were specific to the health care settings and willingness-to-pay thresholds assessed.