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Health utility outcomes in patients undergoing medical management for chronic rhinosinusitis: a prospective multiinstitutional study
Author(s) -
Luk Lauren J.,
Steele Toby O.,
Mace Jess C.,
Soler Zachary M.,
Rudmik Luke,
Smith Timothy L.
Publication year - 2015
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21588
Subject(s) - medicine , cohort , prospective cohort study , chronic rhinosinusitis , cohort study , crossover study , clinical trial , medical therapy , physical therapy , alternative medicine , pathology , placebo
Background A health utility value represents an individual's preference for living in a specific health state and is used in cost‐utility analyses. This study investigates the impact of continuing medical therapy on health utility outcomes in patients with chronic rhinosinusitis (CRS). Methods The Medical Outcomes Study Short Form‐6D (SF‐6D) questionnaire was administered to patients prospectively enrolled in a longitudinal study examining treatment outcomes for CRS. Patients were prescribed robust, initial medical therapy and then elected to continue with medical therapy (n = 40) or undergo endoscopic sinus surgery (ESS), followed by medical therapy (n = 152). Patients observed through treatment crossover to ESS were also evaluated (n = 20). Health utility values (SF‐6D) were generated at baseline, 6‐months, and 12‐months follow‐up for both cohorts and evaluated using repeated measures analysis of variance (ANOVA). Results Treatment crossover patients were found to have a significantly higher prevalence of previous sinus surgery compared to medical management (χ 2 = 6.91; p = 0.009) and surgical intervention (χ 2 = 8.11; p = 0.004) subgroups. Mean baseline utility value for the medical therapy cohort was significantly better compared to the ESS cohort (mean ± standard deviation; 0.76 ± 0.12 vs 0.70 ± 0.15; p = 0.023). Significant improvement in health utility was reported in the ESS cohort (F (2) = 37.69; p < 0.001), whereas values remained stable, without significant improvement, in both the medical therapy cohort (F (2) = 0.03; p = 0.967) and treatment crossover cohort (F (2) = 2.36; p = 0.115). Conclusion Patients electing continued medical management report better baseline health utility compared to patients electing ESS. Patients electing ESS show significant improvement in health utility, whereas those electing continued medical management demonstrate stable health utility over 12 months.