Cost effectiveness of posterior epistaxis management using a gelatin-thrombin matrix or rapid rhino

Background: Epistaxis is common, accounting for over 25% of otolaryngology emergency presentations. Posterior epistaxis is sometimes difficult to manage and can result in serious complications. Traditionally management has involved the use of non-dissolvable nasal packs such as ribbon gauze or the Rapid Rhino. Biological dissolvable matrices have been shown to be effective in achieving haemostasis in posterior epistaxis. Whilst both gelatin-thrombin matrices and the Rapid Rhino provide an effective treatment for epistaxis, there is no published data investigating cost within the Australian healthcare setting. This study evaluated and compared the cost-effectiveness of both products for the treatment of posterior epistaxis. Methods: A decision tree model was constructed to evaluate the cost-effectiveness of the management of posterior epistaxis using FloSeal (gelatin-thrombin matrix) compared to Rapid Rhino from an Australian healthcare perspective in a short time horizon. Results: The mean cost of each modality was A$961 per patient (standard deviation A$229) for the gelatin-thrombin matrix and A$1004 (standard deviation A$138) for the Rapid Rhino. The mean effectiveness of the gelatin-thrombin matrix in managing posterior epistaxis is 0.80 and for Rapid Rhino is 0.65 leading to a cost saving of A$292 per posterior epistaxis case managed if using gelatin-thrombin matrix instead of the Rapid Rhino. Conclusions: Gelatin-thrombin matrix represents a cost-saving alternative to nasal packing and should be considered as first line treatment in patients presenting with posterior epistaxis.