{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:39:52Z","timestamp":1791477592504,"version":"4.3.4"},"reference-count":28,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2013,1,10]],"date-time":"2013-01-10T00:00:00Z","timestamp":1357776000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2013,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The advent of endoscopic sphenopalatine artery ligation (ESPAL) for the control of posterior epistaxis provides an effective, low\u2010morbidity treatment option. In the current practice algorithm, ESPAL is pursued after failure of posterior packing. Given the morbidity and limited effectiveness of posterior packing, we sought to determine the cost\u2010effectiveness of first\u2010line ESPAL compared to the current practice model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A standard decision analysis model was constructed comparing first\u2010line ESPAL and current practice algorithms. A literature search was performed to determine event probabilities and published Medicare data largely provided cost parameters. The primary outcomes were cost of treatment and resolution of epistaxis. One\u2010way sensitivity analysis was performed for key parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Costs for the first\u2010line ESPAL arm and the current practice arm were $6450 and $8246, respectively. One\u2010way sensitivity analyses were performed for key variables including duration of packing. The baseline difference of $1796 in favor of the first\u2010line ESPAL arm was increased to $6263 when the duration of nasal packing was increased from 3 to 5 days. Current practice was favored (cost savings of $437 per patient) if posterior packing duration was decreased from 3 to 2 days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrates that ESPAL is cost\u2010saving as first\u2010line therapy for posterior epistaxis. Given the improved effectiveness and patient comfort of ESPAL compared to posterior packing, ESPAL should be offered as an initial treatment option for medically stable patients with posterior epistaxis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.21137","type":"journal-article","created":{"date-parts":[[2013,1,10]],"date-time":"2013-01-10T21:45:46Z","timestamp":1357854346000},"page":"563-566","source":"Crossref","is-referenced-by-count":39,"title":["Cost\u2010effectiveness of endoscopic sphenopalatine artery ligation versus nasal packing as first\u2010line treatment for posterior epistaxis"],"prefix":"10.1002","volume":"3","author":[{"given":"Raj C.","family":"Dedhia","sequence":"first","affiliation":[{"name":"Department of Otolaryngology University of Pittsburgh School of Medicine  Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamit S.","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Medicine and Dentistry of New Jersey (UMDNJ)\u2013Robert Wood Johnson Medical School  New Brunswick NJ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth J.","family":"Smith","sequence":"additional","affiliation":[{"name":"Section of Decision Sciences and Clinical Systems Modeling University of Pittsburgh School of Medicine  Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Pittsburgh School of Medicine  Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry M.","family":"Schaitkin","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Pittsburgh School of Medicine  Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl H.","family":"Snyderman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Pittsburgh School of Medicine  Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric W.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Pittsburgh School of Medicine  Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,1,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-59989770205-5"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016487409129566"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198712000-00003"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2273.1991.tb02076.x"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200209000-00008"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21064"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.2310\/7070.2004.00185"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940911800907"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100132657"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(95)70169-9"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100116214"},{"key":"e_1_2_6_13_1","doi-asserted-by":"crossref","first-page":"474","DOI":"10.4193\/Rhino10.313","article-title":"On the effectiveness of treatment options in epistaxis: an analysis of 678 interventions","volume":"49","author":"Soyka MB","year":"2011","journal-title":"Rhinology"},{"key":"e_1_2_6_14_1","first-page":"228","article-title":"[Utility of the surgical treatment for severe epistaxis by endoscopic approach of sphenopalatine and ethmoidal arteries]","volume":"57","author":"Ugena E","year":"2006","journal-title":"Acta Otorrinolaringol Esp"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2173-5735(10)70034-X"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/014556131209100209"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2009.23.3294"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhn.2001.113512"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2273.2000.00372.x"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.2500\/105065800779954455"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.2500\/105065899782106805"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215106003379"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100139301"},{"key":"e_1_2_6_24_1","unstructured":"HCUP Overview.Healthcare Cost and Utilization Project (HCUP). 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