Cost‐effectiveness of trans‐nasal endoscopic sphenopalatine artery ligation vs arterial embolisation for intractable epistaxis: Long‐term analyses
Nadège Costa  Michael Mounié  Geraldine Bernard  Laurent Bieler  Laurent Molinier  Elie Serrano Guillaume de Bonnecaze
First published: 05 February 2019 https://doi.org/10.1111/coa.13299
Presented at a meeting: This study was presented at the ‐ IFOS ENT World Congress, 24‐28 June 2017, Paris, France
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Abstract
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.