Case study: HTW appraisal of Floseal in the treatment of epistaxis
What did we do:
HTW looked at the evidence for the clinical and cost effectiveness of flowable haemostatic matrices, made of gelatine and thrombin, to control nosebleeds that have not been stopped with first aid measures.
Who with: This topic was suggested by the manufacturer of Floseal, an example of a gelatine-thrombin matrix, and ENT consultants helped by reviewing our report.
What did we learn:
Floseal appears to be effective at controlling nosebleeds up to 14 days, and the effectiveness is similar to nasal packing. Not needing to remove Floseal after initial treatment may provide an advantage over nasal packing as the removal of this can lead to re-bleeding and the need for further treatment. It was less certain whether the need to be admitted to hospital or the length of hospital stay was different with Floseal compared to nasal packing. However, patients generally preferred Floseal and found it to be less painful than nasal packing.
Economic studies identified estimated Floseal to be either dominant or cost effective compared to nasal packing. However, these studies were not directly applicable to the Welsh NHS perspective with potentially serious limitations. HTW developed new economic modelling using a Welsh NHS perspective. Over a 30-day time horizon, the base case analysis estimated that Floseal reduced 0.295 rebleed events and increased healthcare costs by £80, per patient, when compared to nasal packing. It was estimated that, at a cost effectiveness threshold of £20,000 per quality-adjusted life year (QALY), a gain of at least 0.004 QALYs would be needed to conclude that Floseal is cost effective. The analysis was limited to effectiveness evidence which lacked statistical significance and, therefore, outcomes of this economic analysis should be interpreted with caution.
What were the reactions:
What difference did it make: HTW issued guidance recommending the routine adoption of Floseal as an option to treatment acute nosebleeds.
