title: Economic analysis of the treatment of posterior epistaxis.
abstract: BACKGROUND
  The aim of this study was to compare the economic impact of controlling posterior epistaxis by transnasal endoscopic sphenopalatine artery ligation (TESPAL) and endovascular embolization.
  
  
  METHODS
  We conducted a retrospective chart review of patients undergoing treatment of posterior epistaxis by either TESPAL or embolization. International Classification of Diseases 9 code 784.7 (epistaxis) was the initial screen followed by common procedural terminology codes for TESPAL and angiography with embolization. The total charges and direct costs for TESPAL and endovascular embolization were determined. An unpaired Student's t-test was used to evaluate statistical significance.
  
  
  RESULTS
  Analysis revealed 25 patients that met inclusion criteria. The mean total charge was $14,088 for embolization and $7561 for TESPAL. The differences were statistically significant (p < 0.00006). Costs, defined as reimbursement by third-party payers and direct payments, varied widely and their difference did not reach statistical significance in this sample.
  
  
  CONCLUSIONS
  Our data established no economic advantage for angiography and, in fact, show a trend toward this treatment being more expensive than TESPAL. TESPAL is a procedure that can be performed quickly and on an outpatient basis without the need for angiography equipment or expertise. Additionally, the procedure provides the advantage of a comprehensive endoscopic nasal evaluation for ruling out tumors or other intranasal lesions. With equal efficacy, at least equal costs and equal risk, and additional diagnostic advantages, TESPAL is a more rational treatment for posterior epistaxis.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah 84132, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Miller
authors.forename: Edwin S
authors.initials: ES
authors.lastname: Stevens
authors.forename: Richard R
authors.initials: RR
authors.lastname: Orlandi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D002648:Child; D004180:Direct Service Costs; D004621:Embolization, Therapeutic / Q000191:economics* / Q000379:methods; D004724:Endoscopy / Q000191:economics* / Q000379:methods; D004844:Epistaxis / Q000000981:diagnostic imaging / Q000191:economics* / Q000628:therapy*; D005251:Fees, Medical; D005260:Female; D006801:Humans; D008026:Ligation / Q000191:economics / Q000379:methods; D008297:Male; D008438:Maxillary Artery / Q000601:surgery*; D008875:Middle Aged; D010159:Palate / Q000098:blood supply; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000098:blood supply