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

2019 ◽  
Vol 44 (4) ◽  
pp. 511-517
Author(s):  
Nadège Costa ◽  
Michael Mounié ◽  
Geraldine Bernard ◽  
Laurent Bieler ◽  
Laurent Molinier ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Artery Ligation ◽  
Sphenopalatine Artery ◽  
Arterial Embolisation ◽  
Intractable Epistaxis

Transnasal Endoscopic Sphenopalatine Artery Ligation Compared With Embolization for Intractable Epistaxis: A Long-term Analysis

2018 ◽  
Vol 32 (3) ◽  
pp. 188-193 ◽  
Author(s):  
G. de Bonnecaze ◽  
Y. Gallois ◽  
F. Bonneville ◽  
S. Vergez ◽  
B. Chaput ◽  
...  
Keyword(s):  
Success Rate ◽  
Significant Risk ◽  
Facial Artery ◽  
Artery Ligation ◽  
Selective Embolization ◽  
Surgical Ligation ◽  
Sphenopalatine Artery ◽  
Significant Difference ◽  
Intractable Epistaxis

Background Transnasal endoscopic sphenopalatine artery ligation (TESPAL) and selective embolization both provide excellent treatment success rate in the management of intractable epistaxis. Few long-term studies comparing these approaches have been previously published. Recommendations often present these techniques as alternatives, but there is no clear consensus. Objective The purpose of this study was to evaluate and compare the clinical efficacy of sphenopalatine artery ligation versus embolization to control intractable epistaxis. Methods We performed a retrospective study including all patients referred to our tertiary medical center for severe epistaxis and treated by surgical ligation and/or embolization. The patients were classified into 2 groups: those who underwent TESPAL only and those who underwent endovascular embolization only. We evaluate and compare long-term clinical outcomes after surgical ligation or embolization for the control of intractable epistaxis in terms of effectiveness (recurrence rate) and safety (complication rate). Results Forty-one procedures of supraselective embolization and 39 procedures of surgical ligation for intractable epistaxis are reported and analyzed. No significant difference was observed between the groups in terms of demographic factors, comorbidities, or average length of hospital stay. The 1-year success rate was similar (75%) in both groups. Complications (minor and/or major) occurred in 34% cases in the embolization group and in 18% in the surgical group ( P = .09, ns). Bilateral embolization including facial artery was the only treatment method associated with a significant risk of complications ( P = .015). Conclusion TESPAL seems to provide a similar control rate with a decrease in the number of complications compared to selective embolization in the context of intractable epistaxis. Further studies are required.

scholarly journals Endovascular treatment of intractable epistaxis - results of a 4-year local audit

2004 ◽  
Vol 8 (3) ◽  
pp. 9 ◽  
Author(s):  
Ian C Duncan ◽  
P.A. Fourie ◽  
C.E. Le Grange ◽  
H.A. Van der Walt
Keyword(s):  
Success Rate ◽  
Morbidity Rate ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Artery Ligation ◽  
Endovascular Embolisation ◽  
Long Term Follow Up ◽  
Initial Procedure ◽  
Intractable Epistaxis

A total of 57 endovascular embolisation procedures were performed for intractable epistaxis in 51 patients over a 4-year period at the Unitas Interventional Unit near Pretoria. Long-term follow-up was possible in 36 patients. Three cases were due to trauma and 2 directly related to previous facial surgery, 1 patient had hereditary haemorrhagic telangiectasia (HHT), and the remaining 45 cases (88.2%) were classed as idiopathic. Eight patients (15.7%) had a rebleed between 1 and 33 days after the initial embolisation. Four were re-embolised once, 1 was re-embolised twice (the HHT patient), and 2 underwent additional ethmoid artery ligation (with no further bleeding). This gives a primary short-term success rate (in all 51 cases) of 86.3% and a secondary assisted success rate of 94.1% for embolisation alone. Long-term follow- up was obtained in 36 patients, with 35 (97.2%) reporting no further bleeding after the initial procedure(s). Only the patient with HHT developed multiple recurrent bleeds. The mortality rate was 0%, the major morbidity rate 2% (1 stroke), and the minor morbidity rate 25% (N = 36), which included transient facial pain, headaches and femoral problems related to access. Our results compare favourably with other published series. In conclusion, endovascular embolisation for intractable epistaxis is available locally as an alternative technique for the treatment

Cost-effectiveness of endoscopic sphenopalatine artery ligation versus nasal packing as first-line treatment for posterior epistaxis

2013 ◽  
Vol 3 (7) ◽  
pp. 563-566 ◽  
Author(s):  
Raj C. Dedhia ◽  
Shamit S. Desai ◽  
Kenneth J. Smith ◽  
Stella Lee ◽  
Barry M. Schaitkin ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Nasal Packing ◽  
Line Treatment ◽  
First Line ◽  
Artery Ligation ◽  
Sphenopalatine Artery ◽  
First Line Treatment

Endoscopic control of the sphenopalatine artery for epistaxis: long-term results

2007 ◽  
Vol 121 (8) ◽  
pp. 759-762 ◽  
Author(s):  
M Abdelkader ◽  
S C Leong ◽  
P S White
Keyword(s):  
Treatment Success ◽  
Effective Means ◽  
Late Recurrence ◽  
Long Term Results ◽  
Artery Ligation ◽  
Sphenopalatine Artery ◽  
Endoscopic Control ◽  
Long Term Follow Up ◽  
Endoscopic Ligation

AbstractThe aim of this study was to prospectively evaluate post-operative cessation of bleeding and late recurrence of epistaxis in a cohort of patients treated by endoscopic ligation of the sphenopalatine artery. Participants comprised patients undergoing sphenopalatine artery ligation for posterior epistaxis at three east Scotland hospitals. Main outcome measures were recurrence of epistaxis in the immediate post-operative period and at long-term follow up (minimum nine months). Forty-three patients (30 men and 13 women) underwent 45 procedures; two patients underwent bilateral ligation. Two patients suffered recurrence as in-patients. Two patients experienced subsequent epistaxis requiring medical treatment. Two further patients suffered minor late epistaxis not requiring treatment. Success in preventing significant recurrence was 93 per cent. All recurrences requiring intervention occurred within one month of surgery. None of the patients in this series reported nasal complications. We found sphenopalatine artery ligation to be an effective means of achieving long-term control of posterior epistaxis.

Long-term cost-effectiveness of insulin detemir versus NPH in type 2 diabetes patient: An evaluation in the German setting

2007 ◽  
Vol 2 (04) ◽  
Author(s):  
W Valentine ◽  
M Aagren ◽  
R Kotchie ◽  
G Goodall
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Insulin Detemir ◽  
Diabetes Patient

Long-term treatment costs and cost-effectiveness of restoration repair versus replacement

2021 ◽  
Author(s):  
Philipp Kanzow ◽  
Joachim Krois ◽  
Annette Wiegand ◽  
Falk Schwendicke
Keyword(s):  
Cost Effectiveness ◽  
Term Treatment ◽  
Treatment Costs ◽  
Long Term Treatment

scholarly journals Cost-Effectiveness Analysis Of Using Levonorgestrel-Releasing Intrauterine System In Long-Term Contraception In Colombia

2013 ◽  
Vol 16 (3) ◽  
pp. A74-A75
Author(s):  
M. Romero ◽  
L. Huerfano ◽  
F. Espinel
Keyword(s):  
Cost Effectiveness ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis

scholarly journals Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takahiro Kinoshita ◽  
Kensuke Moriwaki ◽  
Nao Hanaki ◽  
Tetsuhisa Kitamura ◽  
Kazuma Yamakawa ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Emergency Room ◽  
Healthcare Costs ◽  
Cost Effective ◽  
Severe Trauma ◽  
Third Party ◽  
Trauma Patients ◽  
Short Term ◽  
The Third

Abstract Background Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). Methods We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted. Results The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. Conclusion The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.

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