Management of Anterior Epistaxis in the Emergency Department Using Rapid Rhino and Merocel: A Cost Analysis.

Abstract

Importance: Epistaxis affects approximately 60% of the population over their lifetime. When conservative attempts fail, nasal tampons are often required to stop anterior bleeding. Health economics is critical in our publicly funded system. Determination of cost-effective interventions is crucial.

Objective: To compare the total cost of Merocel and Rapid Rhino from the perspective of a provincial payer and an academic hospital for the management of anterior epistaxis.

Design: Retrospective review.

Setting: London Health Sciences Centre emergency department (Victoria and University campus).

Participants: Patients ≥18 years of age presenting with anterior epistaxis. The participants were 67% men and 33% women. Approximately, 63% were on anticoagulant medication, and 35% used an ambulance to arrive at the hospital.

Intervention: Rapid Rhino or Merocele, which was dependent on the site of presentation.

Main outcome measures: Rebleed rate.

Results: The rate of rebleeds with Merocel was 42% (26/62), whereas it was 24% (4/17) with Rapid Rhino. The inverse probability weighted regression adjustment results show that patients receiving Rapid Rhino did not have a statistically significant difference in costs per patient ($62.40, 95% CI: -$25.75 to $150.55) from the hospital perspective or the provincial health care payer perspective ($78.25, 95% CI: -$18.38 to $174.89).

Conclusion and relevance: There was no significant difference in cost between Rapid Rhino and Merocel for anterior epistaxis from a hospital or provincial payer perspective.