Objectives: Trans-nasal endoscopic sphenopalatine artery ligation (TESPAL) and endovascular arterial embolisation both provide excellent success rates for intractable epistaxis. Recent economic models suggest that TESPAL could be a cost-saving strategy. Our main aim was to perform cost-effectiveness analyses on TESPAL compared with embolisation to treat patients with epistaxis.
Design: We performed retrospective, monocentric, comparative analyses on patients referred to our centre and treated with embolisation or TESPAL.
Setting: This economic evaluation was carried out from a payer's perspective (ie French National Health Insurance) within a time horizon of 12 months.
Participants: Thirty-seven TESPAL procedures and thirty-nine embolisation procedures to treat intractable epistaxis were used in the analyses.
Main outcome measures: The primary outcome is presented as the cost per 1% of non-recurrence. Effectiveness was defined as avoiding recurrence of epistaxis during the 1-year follow-up. Cost estimates were performed from the payer's perspective.
Results: Hospitalisation costs were higher for embolisation compared with TESPAL (5972 vs 3769 euros). On average, hospitalisation costs decreased by 41% when a patient was treated by TESPAL compared with an embolisation strategy (P = 0.06). The presence of comorbidities increased hospitalisation costs by 79% (P = 0.04). TESPAL enabled 1867€ to be gained in intractable epistaxis.
Conclusions: The outcomes from our decision model confirm that TESPAL is more cost-effective for patients with intractable epistaxis.
Keywords: cost-effectiveness; embolisation; hospitalisation costs; intractable epistaxis; trans-nasal endoscopic sphenopalatine artery ligation.
© 2019 John Wiley & Sons Ltd.