0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Cost-effectiveness Analysis of Endoscopic Sphenopalatine Artery Ligation vs Arterial Embolization for Intractable Epistaxis

Luke Rudmik, MD, MSc1; Randy Leung, MD2
[+] Author Affiliations
1Division of Otolaryngology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
2Deparment of Otolaryngology–Head and Neck Surgery, University of Toronto, Royal Victoria Regional Health Centre, Barrie, Ontario, Canada
JAMA Otolaryngol Head Neck Surg. 2014;140(9):802-808. doi:10.1001/jamaoto.2014.1450.
Text Size: A A A
Published online

Importance  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.

Design, Setting, and Participants  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.

Interventions  TESPAL and endovascular arterial embolization.

Main Outcome and Measures  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 and Relevance  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.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure 1.
Decision Tree Model of TESPAL vs Embolization

See Table 1 for a description of the variables used. Postop indicates postoperative; rebleed indicates episode of rebleeding; SPA, sphenopalatine artery; TESPAL, transnasal endoscopic sphenopalatine artery ligation.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Cost-effective Acceptability Curve of TESPAL vs Embolization for Treatment of Intractable Epistaxis

TESPAL indicates transnasal endoscopic sphenopalatine artery ligation.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
ICER Scatterplot of TESPAL vs Embolization for Treatment of Intractable Epistaxis

ICER indicates incremental cost-effectiveness ratio; TESPAL, transnasal endoscopic sphenopalatine artery ligation; WTP, willingness to pay.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();