Authors' objectives: This report aims to identify and summarise evidence that addresses the following research question: What is the clinical and cost-effectiveness of flowable haemostatic matrices, containing gelatine and thrombin, in the treatment of acute epistaxis?

Authors' results and conclusions: Evidence from comparative studies generally showed that Floseal gelatine-thrombin haemostatic matrix was as effective as conventional nasal packing at controlling epistaxis. Non-comparative studies also found Floseal to be effective at controlling bleeding, with similar results reported as the majority of the comparative studies. Hospital admission rates after Floseal treatment varied, but lengths of hospital stay tended to be shorter than those admitted after conventional nasal packing. The requirement for further treatment after use of Floseal to control epistaxis was generally low and rates were similar to nasal packing. However, Floseal was superior to conventional nasal packing for patient-reported satisfaction with treatment and pain associated with treatment, with high levels of satisfaction and very mild levels of discomfort. There were no adverse events reported with the intervention or comparator and no evidence on quality of life was identified. HTW conducted a new cost effectiveness analysis considering the NHS Wales perspective. It was estimated that, compared to nasal packing, Floseal reduced 0.295 rebleed events and increased healthcare costs by £80 per patient. Since no heath related quality of life evidence was identified, a typical cost-utility analysis could not be performed. However, it was estimated that, at a cost-effectiveness threshold of £20,000 per quality-adjusted life year (QALY), at least 0.004 QALY gains would be needed to conclude that Floseal is cost-effective. The outcomes of the economic analysis should be interpreted with caution due to limitations in the effectiveness evidence used which lacked statistical significance. A review of the available patient-related literature found that epistaxis can have a profound impact on a person’s quality of life. Bleeding can be frightening and lead to feelings of loss of control, helplessness, and fear. Advice on management of nosebleeds can be inconsistent and misinformation can be an issue. Self-packing can occur, sometimes after clinician-led training, and while it can help people resume a sense of control, it can be painful and it comes with certain risks, such as accidental swallowing of packing materials and choking.

Authors' recommendations: The evidence supports the routine adoption of Floseal gelatine-thrombin haemostatic matrix as a treatment option in people with acute epistaxis. The available evidence suggests that Floseal is as effective as nasal packing with non-dissolvable material at stopping bleeding for up to 14 days and may reduce the rate of overall re-bleeding. Floseal is associated with reduced pain and better patient satisfaction during treatment than conventional nasal packing. Although Floseal for the treatment of acute epistaxis is cost-incurring, with a cost of £271 per re-bleed prevented, it is considered to be a plausibly cost-effective intervention.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: HTW recommends the acquisition of evidence on the effectiveness of gelatine-thrombin haemostatic matrices for children with acute epistaxis.

Project Status: Completed

Year Published: 2024

URL for published report: https://healthtechnology.wales/reports-guidance/floseal-in-the-treatment-of-epistaxis/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk