Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science


Epidemiology and Biostatistics


Sisira Sarma

2nd Supervisor

Leigh Sowerby


3rd Supervisor

Guangyong Zou

Joint Supervisor


When patients present to an emergency room (ER) with a nosebleed, one technique that physicians employ is the application of nasal packing. Merocel is a common nasal pack utilized in ER because of their low cost. Rapid Rhino is a nasal packing that is more comfortable for patients but is more costly than Merocel. Costing for epistaxis treatment is more than initial treatment costs and needs to consider rebleed rates. Using a retrospective cohort study design with covariates adjusted by propensity scores, we compared the costs associated with Merocel, and Rapid Rhino from the hospital and provincial healthcare perspectives. Merocel had a 26/62 (42%) total rebleed rate contrasted to Rapid Rhino’s 4/17 (24%). For both the hospital and provincial perspectives, our sample did not provide evidence that there was difference in costs between Merocel and Rapid Rhino.

Summary for Lay Audience

When epistaxis occurs, the bleed is often self-limited. However, in some cases the bleeding does not stop, and the patient requires additional medical intervention. Emergency room physicians will typically attempt further conservative management, like applying pressure to the nose and decongestion before consideration of invasive methods. Nasal packing is one option when these conservative methods fail. Merocel is a commonly utilized nasal pack in the ER as the direct material costs for these packs are relatively cheaper to other options. In comparison, other nasal packs like Rapid Rhino are more expensive but more comfortable for patients.

However, costs associated with nasal packing are more than just direct material costs. A major contributor to costs is rebleeds. If patients experience a greater rate of rebleed using one pack, they return to the ER again incurring additional costs. Unfortunately, there are few studies comparing rebleed rates of Merocel to Rapid Rhino directly, and even fewer cost-analysis that include rebleed rates for both nasal packs.

A retrospective review of medical charts for adult anterior epistaxis patients during the year 2018 presenting at University and Victoria hospital ERs was conducted. Patients were followed-up for two weeks to assess rebleed rates. Total costs were assessed using both inverse probability weight and covariate balancing propensity score weighting for the hospital and provincial health care perspectives.

The sample size for Rapid Rhino was 17, while the Merocel sample size was 62. Our total rate of rebleeds in Merocel was 42% (26/62) compared to 24% (4/17) in Rapid Rhino. Patients receiving Rapid Rhino have statistically non-significant difference in costs per patient ($61.61, 95% CI: -$127.84 to $251.05) for the hospital perspective as well as the provincial health care perspective ($78.14, 95% CI: -$89.54 to $245.83). Our sample did not suggest differences in costs for using Merocel and Rapid Rhino in treatment of epistaxis in the emergency room.

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This work is licensed under a Creative Commons Attribution 4.0 License.

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