Nithianandan Harrish, Thavorn Kednapa, Banaz Fatmahalzahra, Macdonald Kristian, Lasso Andrea, Kilty Shaun J
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada.
World J Otorhinolaryngol Head Neck Surg. 2019 Dec 30;5(4):193-199. doi: 10.1016/j.wjorl.2019.11.001. eCollection 2019 Dec.
To estimate the hospital costs of managing anterior epistaxis in the Emergency Department at a Tertiary Care centre in Canada.
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.
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® ( < 0.001) even after potential confounding factors were controlled.
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.
估算加拿大一家三级医疗中心急诊科处理前位鼻出血的住院费用。
基于对2012年1月至2014年5月急诊科就诊情况的回顾性分析进行成本分析。纳入连续抽样的诊断为前位鼻出血的成年患者。前位鼻出血通过以下方式之一进行处理：鼻夹、藻酸钙止血材料、硝酸银烧灼、凡士林填塞、其他治疗或不治疗。从前位鼻出血治疗的直接和间接住院费用（加元）均从医院角度进行计算。使用广义线性模型评估治疗方式与总住院费用之间的关联，同时控制潜在的混杂因素。
分析纳入了353例患者（49%为女性），平均年龄为（69.9±18.5）岁。治疗费用的中位数（四分位间距）从观察的227.83加元（167.96加元，328.69加元）到藻酸钙止血材料的763.98加元（632.25加元，830.23加元）不等。所有治疗方式的前位鼻出血管理的总体住院费用中位数为566.24加元（459.61加元，753.46加元）。即使在控制了潜在的混杂因素后，与藻酸钙止血材料相比，硝酸银、鼻夹和观察在统计学上与较低的费用相关（<0.001）。
我们的结果显示不同治疗方式的鼻出血住院费用差异很大。这些成本估算可为未来旨在指导鼻出血患者医疗资源分配的经济评估研究提供参考。
