Endoscopic Management for Non-variceal Upper Gastrointestinal Bleeding: A Network Meta-analysis of Randomized Controlled Trials and Cost-Effectiveness Analyses of Two Healthcare Systems
Issued Date
2026-01-01
Resource Type
ISSN
00029270
eISSN
15720241
Scopus ID
2-s2.0-105036682223
Pubmed ID
41873865
Journal Title
American Journal of Gastroenterology
Rights Holder(s)
SCOPUS
Bibliographic Citation
American Journal of Gastroenterology (2026)
Suggested Citation
Siranart N., Chumpangern Y., Pajareya P., Nakaphan P., Kassels T., Chuanchai W., Sattawatthamrong S., Fangsaard P., Tangpradubkiat P., Steinway S.N., Tantitanawat K., Chirapongsathorn S. Endoscopic Management for Non-variceal Upper Gastrointestinal Bleeding: A Network Meta-analysis of Randomized Controlled Trials and Cost-Effectiveness Analyses of Two Healthcare Systems. American Journal of Gastroenterology (2026). doi:10.14309/ajg.0000000000004000 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116472
Title
Endoscopic Management for Non-variceal Upper Gastrointestinal Bleeding: A Network Meta-analysis of Randomized Controlled Trials and Cost-Effectiveness Analyses of Two Healthcare Systems
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: – Non-variceal upper gastrointestinal bleeding (NVGIB) represents an urgent medical condition with high mortality. Standard endoscopic therapies (ST) still carry a high rebleeding rate. Novel modalities such as the over-the-scope clip (OTSC) and hemostatic powder (HP) could be promising alternatives, but their efficacy and cost-effectiveness remain to be explored.Methods: – A network meta-analysis and cost-effectiveness analyses were conducted to compare OTSC vs. HP vs. ST. Primary endpoints include 30-day rebleeding and 30-day further bleeding. Markov models with a 12-month time horizon were created across 3 different healthcare settings: the United States (US), Thailand with Boston Scientific products (TH-BOS), and Thailand with China-manufactured alternatives (TH-CHN). Incremental cost-effectiveness ratio (ICER) was evaluated at a willingness-to-pay (WTP) of $100, 000 per quality-adjusted life year (QALY) for the US model and THB150, 000 per QALY for the TH-BOS and TH-CHN models.Results: – Ten RCTs with 1, 120 NVGIB patients were included in the NMA. Lowest 30-day rebleeding was seen in OTSC (P-score:0.996), followed by ST (0.296) and HP (0.208). Similarly, OTSC also achieved lowest 30-day further bleeding (0.906), followed by HP (0.570) and ST (0.024). In CEA, the US model reported OTSC as a dominant approach compared to HP (ICER: –$314) and ST (–$3, 112). In the TH model, OTSC still dominated ST (ICER:–THB28, 423 for TH-BOS and –22, 858 for TH-CHN) and was more cost-effective than HP (THB1, 833 for TH-BOS and THB2, 026 for TH-CHN).Conclusion: – OTSC was superior to HP and ST in terms of efficacy and cost-effectiveness, favoring its use as a first-line endoscopic hemostasis intervention for NVGIB.