Cost‐effectiveness of trans‐nasal endoscopic sphenopalatine artery ligation vs arterial embolisation for intractable epistaxis: Long‐term analyses

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.