J. X. Yu et al., Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA, evaluated by mathematic modelling the cost-effectiveness of OTSC clips for the treatment of peptic ulcer bleeding as first-line and second-line therapy. A decision tree was used to model the cost, effectiveness, and rates of persistent/recurrent bleeding of OTSC versus standard treatment (ST) for the management of peptic ulcer bleeding.

Three possible treatment strategies were modeled for a patient with peptic ulcer bleeding: OTSC clipping after first line standard therapy, a repeat of standard therapy after first-line standard therapy, and standard therapy after first-line OTSC clipping. It was assumed that if the second-line therapy remained unsuccessful, the patient would undergo interventional radiology or surgery.

The average cost of standard treatment was based on the cost of one hemoclip and a gold probe. The cost of an esophagogastroduodenoscopy and for hospitalization were estimated from Medicare and Medicaid data, the probability of persistent/recurrent bleeding with standard therapy and OTSC therapy was obtained through review of the literature.

Results showed that the first treatment strategy of first-line ST followed by OTSC was the most cost-effective strategy, costing $ 6,298 per patient and resulting in 0.0686 QALYs. The second strategy with ST followed by ST cost $ 6,576 and resulted in 0.0659 QALYs. The third strategy with OTSC as first-line treatment and second-line ST cost $ 6,490 and resulted in 0.0687 QALYs. As the probability of persistent/recurrent bleeding following ST increases, OTSC treatment becomes preferred in more scenarios. Specifically, for medium- or high-risk ulcer with Rockall ≥ 4, OTSC as first line therapy followed by ST is preferred.

The authors concluded that in patients with persistent/recurrent peptic ulcer bleeding after standard endoscopic treatment a repeat of the standard approach is not cost-effective. Instead, OTSC clipping should be used. For first-line therapy, OTSC clipping should be considered for patients with intermediate or high-risk ulcers as determined by the Rockall score.