By David, Clinical Affairs Manager for the Endoscopy Division
There is one question that is difficult to answer: Where does Hemospray® Endoscopic Hemostat fit in the hemostasis treatment algorithm? Physicians are comfortable with the traditional methods of hemostasis, and clips like Cook’s Instinct™ Endoscopic Hemoclip address various types of GI bleeding. But there are always instances where conventional treatments with injection, clips, or cautery don’t do the job. Historically, for some physicians, Hemospray has been considered after conventional treatments fail, where the only remaining option is surgery or embolization.
As physicians gain experience with the device, they challenge the assumption of Hemospray being limited to these rescue situations. Many published case series support the use of Hemospray as part of the primary treatment approach. However, the question of where Hemospray fits and how cost effective it is compared to traditional dual therapy remains … until now. To address these questions, Alan Barkun and colleagues* developed a cost model that evaluates treatment options for patients with high-risk nonvariceal upper GI bleeding.
The authors used a practical approach that compared one of four possible hemostatic strategies: Hemospray alone; traditional therapy (use of either a combination of modalities or sole ligation or thermal devices); Hemospray followed by traditional treatment, if needed; or traditional hemostasis followed by Hemospray, if needed. The model estimates that using traditional therapy for active upper gastrointestinal hemorrhage in this high-risk population prevents rebleeding in 81% of cases (19% rebleeding rate). Adding Hemospray to the traditional approach improves the effectiveness to 97% (only 3% rebleeding) and reduces the average cost per patient.
Based on these assumptions, Hemospray appears to be a useful addition that may provide economic value to the therapeutic armamentarium of digestive endoscopists when treating patients with nonvariceal upper GI bleeding. As with any theoretical analysis, “your mileage may vary.” However, when viewed as a whole from this paper, we see the initial cost of Hemospray is outweighed by the potential for improving patient outcomes, which is the goal for any new treatment. We are pleased to be able to offer this study as a talking point and hope it will help keep Hemospray in the forefront of conversation about cost-effective approaches to hemostasis.
* Barkun AN, Adam V, Lu Y, et al. Using Hemospray Improves the Cost-effectiveness Ratio in the Management of Upper Gastrointestinal Nonvariceal Bleeding. Journal of Clinical Gastroenterology. Journal of Clinical Gastroenterology. 2018 Jan; 52(1):36-44.
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Dr. Alan Barkun is a paid consultant of Cook Medical.