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The value of frontal sinusotomy for chronic rhinosinusitis with nasal polyps—A cost utility analysis
Author(s) -
Scangas George A.,
Lehmann Ashton E.,
Remenschneider Aaron K.,
Su Brooke M.,
Shrime Mark G.,
Metson Ralph
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26783
Subject(s) - medicine , chronic rhinosinusitis , nasal polyps , sinusitis , cohort , endoscopic sinus surgery , quality adjusted life year , surgery , cost effectiveness , risk analysis (engineering)
Objectives/Hypothesis The number of surgical procedures performed for frontal sinusitis and the associated costs have increased dramatically over the past decade. The purpose of this study was to evaluate the cost‐effectiveness of endoscopic frontal sinusotomy (EFS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). Study Design Cohort‐style Markov decision‐tree economic model with a 36‐year time horizon. Methods Matched cohorts of CRSwNP patients who underwent endoscopic sinus surgery (ESS) with (n = 139) and without (n = 49) EFS were compared to each other and to patients (n = 139) from the Medical Expenditures Survey Panel database who underwent medical management for chronic rhinosinusitis. Multi‐year health utility values were calculated from responses to the EuroQol 5‐Dimension instrument. The primary outcome measure was the incremental cost‐effectiveness ratio (ICER). Results Decision analysis showed that ESS without EFS proved more cost‐effective than ESS with EFS or medical management. ESS without EFS compared to medical management yielded an ICER of $9,004/quality‐adjusted life year (QALY). ESS with EFS compared to ESS without EFS yielded an ICER of $62,310/QALY. At a willingness‐to‐pay (WTP) threshold of $50,000/QALY, ESS without EFS was more cost‐effective than ESS with EFS with 52.1% certainty. These results were robust to one‐way analysis and probabilistic sensitivity analysis. Conclusions ESS remains a cost‐effective intervention compared to medical therapy alone for patients with CRSwNP. In this study, the addition of frontal sinusotomy during ESS for patients with CRSwNP was not found to be cost‐effective at a WTP threshold of $50,000/QALY, but may be cost effective at a higher threshold of $100,000/QALY. Level of Evidence 2c. Laryngoscope , 128:43–51, 2018