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

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(R),Silver Nitrate cautery,Vaseline packing,other treatment or no treatment.Both the direct and indirect hospital costs(SCDN)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 CS227.83(CS167.96,CS328.69)for observation to CS763.98(CS632.25,CS830.23)for Merocel(R).The overall median total hospital costs incurred across all modalities was CS566.24(CS459.61,CS753.46)for the management of anterior epistaxis.Silver Nitrate,nasal clip,and observation were statistically associated with a lower cost when compared to Merocel(R)(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.

Socioeconomic status and anterior epistaxis in adult population

Objective:Little was known about the role of socioeconomic status as a risk factor for epistaxis in adult population.The objective of this study was to determine whether socioeconomic status influences the presentation to emergency department for anterior epistaxis in an adult population.Methods:Retrospective review of emergency department visits from January 2012 to May 2014.The setting is in an emergency department of a Canadian tertiary care centre.Adult patients with primary diagnosis of anterior epistaxis in the emergency department were included in this study.The main outcome was emergency department visits for anterior epistaxis visits.Results:A total of 351 cases of anterior epistaxis were included.The mean age was 70 years and 51%of patients were male.The patients were stratified into two groups based on whether their age was equal to and above,or below 75 years.Our analysis indicated that those 75 years or older in higher income quintiles have an increased risk of anterior epistaxis compared to the subjects in the lower income quintiles(P<0.05).This association did not hold true for those younger than 75 years or for all age groups combined.Conclusion:There is an association between higher socioeconomic status and the presentation to the emergency department with anterior epistaxis in the population older than 75 years but not in younger patients.