NICE’s role is to improve outcomes for people using the National Health System (NHS) and other public health and social care services in the United Kingdom. It focuses on
- producing evidence-based guidance and advice for health, public health and social care practitioners;
- developing quality standards and performance metrics for those providing and commissioning health, public health and social care services;
- providing a range of information services for commissioners, practitioners and managers across health and social care.
Evidence supports the case for adopting Danis stent for treating acute oesophageal variceal bleeding. Danis stent improves the short-term control of bleeding compared with a balloon tamponade and can be left in place for longer, allowing time for stabilisation.
Danis stent should be considered for people aged 16 and over with acute oesophageal variceal bleeding that does not respond to endoluminal therapy and whose oesophageal varices are being considered for definitive treatment. Also, Danis stent should be considered for people when definitive treatment is not appropriate and if they are likely to be offered palliative care.
Cost modelling shows that Danis stent is cost saving compared with balloon tamponade for acute oesophageal variceal bleeding being considered for definitive treatment. This is because having Danis stent results in a shorter stay in intensive care. To be cost saving, Danis stent needs to decrease intensive care stay by approximately 1 day or more compared with balloon tamponade. For more details, see the NICE resource impact report.
Cost Modelling Results
|Average saving per pacient||2,423 GBP
The main cost drivers of these scenarios were the risk of re-bleeding, the procedure costs and the estimated length of intensive care unit (ICU) stay.
“the cost of transferring a proportion of people from secondary to tertiary care“… “had little effect on the results“
Danis stent is cost saving and length of ICU stay is the main cost driver.
Average expected reduction in length of ICU stay in days
The committee noted that the estimated difference in length of ICU stay had the greatest effect on the direction of the cost case results.
Clinical experts estimated that length of ICU stay for the Danis stent group is 3.6 days, and 6 days for the balloon tamponade group.