title: Cost-effectiveness analysis of endoscopic sphenopalatine artery ligation vs arterial embolization for intractable epistaxis.
abstract: OBJECTIVE
  Intractable epistaxis is a common otolaryngology emergency. Transnasal endoscopic sphenopalatine artery ligation (TESPAL) and endovascular arterial embolization both provide excellent success rates, and therefore the decision to choose one over the other can be challenging.
  
  
  OBJECTIVE
  To aid in decision making by evaluating the cost-effectiveness of TESPAL vs endovascular arterial embolization for intractable epistaxis.
  
  
  METHODS
  Economic evaluation using a decision tree model with a 14-day time horizon for emergency department consultations for patients with intractable epistaxis defined as persistent bleeding despite bilateral anterior nasal packing. The economic perspective was the health care third-party payer. Effectiveness and probability data were obtained from the published medical literature. Costs were obtained from the published literature, the Centers for Medicare & Medicaid Services database, and the Healthcare Cost and Utilization Project database. Multiple sensitivity analyses were performed, including a probabilistic sensitivity analysis. Comparative treatment groups were (1) TESPAL and (2) embolization.
  
  
  METHODS
  TESPAL and endovascular arterial embolization.
  
  
  METHODS
  The primary outcome was the incremental cost-effectiveness ratio (ICER) for successful control of epistaxis.
  
  
  RESULTS
  The reference case demonstrated that the embolization strategy was more effective but more costly compared with the TESPAL strategy: $22,324.70 per 0.70 effectiveness compared with $12,484.14 per 0.68 of effectiveness, respectively. The embolization vs TESPAL ICER was $492,028, which is higher than any willingness to pay (WTP), suggesting that TESPAL is the cost-effective decision. The sensitivity analysis demonstrated a 77.6% and 73.7% certainty that the TESPAL strategy is cost-effective at WTP thresholds of $10,000 and $50,000, respectively.
  
  
  CONCLUSIONS
  Results from this economic evaluation suggest that when both TESPAL and arterial embolization are viable options (based on patient and institutional factors), TESPAL is the more cost-effective treatment strategy for patients with intractable epistaxis.
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Luke
authors.initials: L
authors.lastname: Rudmik
authors.affiliation: Deparment of Otolaryngology-Head and Neck Surgery, University of Toronto, Royal Victoria Regional Health Centre, Barrie, Ontario, Canada.
authors.forename: Randy
authors.initials: R
authors.lastname: Leung
mesh_terms: D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004621:Embolization, Therapeutic / Q000191:economics*; D004636:Emergency Service, Hospital; D004724:Endoscopy / Q000191:economics*; D004844:Epistaxis / Q000191:economics* / Q000628:therapy*; D006801:Humans; D008026:Ligation / Q000191:economics; D008438:Maxillary Artery / Q000601:surgery*; D018803:Models, Economic; D015999:Multivariate Analysis; D014481:United States