Determining the hospital cost of anterior epistaxis treatment modalities at a Canadian tertiary care centre

Harrish Nithianandan; Kednapa Thavorn; Fatmahalzahra Banaz; Kristian Macdonald; Andrea Lasso; Shaun J Kilty

doi:10.1016/j.wjorl.2019.11.001

Determining the hospital cost of anterior epistaxis treatment modalities at a Canadian tertiary care centre

World J Otorhinolaryngol Head Neck Surg. 2019 Dec 30;5(4):193-199. doi: 10.1016/j.wjorl.2019.11.001. eCollection 2019 Dec.

Authors

Harrish Nithianandan¹, Kednapa Thavorn^{2

3

4}, Fatmahalzahra Banaz^{1

5}, Kristian Macdonald^{1

5}, Andrea Lasso², Shaun J Kilty^{1

2

5

6}

Affiliations

¹ Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
² Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada.
³ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁴ Institute for Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, Ontario, Canada.
⁵ Department of Otolaryngology - Head and Neck Surgery, The University of Ottawa, Ottawa, Ontario, Canada.
⁶ Dr. S. Kilty Medicine Prof. Corp., Ottawa, ON, Canada.

Abstract

Objective: To estimate the hospital costs of managing anterior epistaxis in the Emergency Department at a Tertiary Care centre in Canada.

Material and methods: A cost analysis was conducted based on a retrospective review of Emergency Department visits from January 2012 to May 2014. A consecutive sample of adult patients with a diagnosis of anterior epistaxis was included. Anterior epistaxis was managed via one of: Nasal clip, Merocel®, Silver Nitrate cautery, Vaseline packing, other treatment or no treatment. Both the direct and indirect hospital costs ($CDN) for anterior epistaxis treatment were calculated from the hospital's perspective. Generalized linear models were used to assess the association between treatment modalities and total hospital costs while controlling for potential confounding factors.

Results: Three hundred and fifty-three patients (49% female) with a mean age of (69.9 ± 18.5) years were included in the analysis. The median (interquartile ranges) costs of treatment ranged from C$227.83 (C$167.96, C$328.69) for observation to C$763.98 (C$632.25,C$830.23) for Merocel®. The overall median total hospital costs incurred across all modalities was C$566.24 (C$459.61, C$753.46) for the management of anterior epistaxis. Silver Nitrate, nasal clip, and observation were statistically associated with a lower cost when compared to Merocel® (P < 0.001) even after potential confounding factors were controlled.

Conclusions: Our results show wide difference in the hospital cost of epistaxis across treatment modalities. These cost estimates can help inform future economic evaluation studies aiming to guide the allocation of health care resources for patients with epistaxis.

Keywords: Anterior epistaxis; Cautery; Hospital costs; Nasal packing; Silver nitrate.