Abstract
Objectives: Posterior epistaxis is a severe variant of nasal bleeding. Historically, patients have been treated initially with posterior nasal packing, often requiring intensive care unit observation. Studies have confirmed a cost savings if the treatment methods involve earlier surgical or endovascular intervention. Recent advances in endoscopic nasal surgery have produced minimally invasive techniques in controlling posterior epistaxis. Transnasal endoscopic sphenopalatine artery ligation (TESPAL) is one such procedure. Previous studies evaluating the cost and effectiveness of surgical procedures to endovascular embolization included an assortment of surgical procedures that can be supplanted by TESPAL. The present study compares the charges and costs of treating posterior epistaxis by TESPAL and endovascular embolization.
Methods: A retrospective chart review of patients undergoing treatment of posterior epistaxis was performed. ICD-9 code 784.7 (epistaxis) was the initial screen followed by CPT codes for the given procedures, 31238 (TESPAL) and 61626 (angiography and embolization). The total charges and direct costs for TESPAL and endovascular embolization were determined. An unpaired Student t test was employed to evaluate statistical significance.
Results: Analysis revealed 25 patients who met the criteria. The TESPAL treated group contained 7 patients; 18 patients were treated with endovascular embolization. The mean total charge was $14,088 for embolization and $7561 for TESPAL. The differences were statistically significant (P < 0.00006).
Conclusions: Our data demonstrate that a significant economic difference exists between the two treatment options. With equal efficacy and likely equal risk, TESPAL is clearly a more economical treatment strategy for posterior epistaxis.