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Endoscopic polypectomy in the clinic: a pilot cost‐effectiveness analysis
Author(s) -
Rudmik L.,
Smith K.A.,
Kilty S.
Publication year - 2016
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/coa.12473
Subject(s) - medicine , cost effectiveness , economic evaluation , polypectomy , quality adjusted life year , surgery , incremental cost effectiveness ratio , cost effectiveness analysis , epic , colonoscopy , cancer , colorectal cancer , risk analysis (engineering) , pathology , art , literature
Objective The purpose of this pilot economic evaluation was to assess the cost‐effectiveness of the endoscopic polypectomy in the clinic ( EPIC ) procedure compared to formal endoscopic sinus surgery ( ESS ) for the treatment of select chronic rhinosinusitis ( CRS ) patients with nasal polyposis. Design Cost‐effectiveness analysis using a M arkov decision tree model with a 30‐year time horizon. The two comparative treatment groups were as follows: (i) EPIC and (ii) ESS . Costs and effects were discounted at a rate of 3.5%. A probabilistic sensitivity analysis was performed. Setting Economic perspective of the C anadian government third‐party payer. Participants CRS patients with nasal polyposis who have predominantly isolated symptoms of nasal obstruction with or without olfactory loss. Main outcome measures Incremental cost per quality adjusted life year ( QALY ). Results Over a time period of 30 years, the reference case demonstrated that the ESS strategy cost a total of $21 345 and produced 13.17 QALY s while the EPIC strategy cost a total of $5591 and produced 12.93 QALY s. The ESS versus EPIC incremental cost‐effectiveness ratio was $65 641/ QALY . The probability that EPIC is cost‐effective compared to ESS at a maximum willingness‐to‐pay threshold of $30 000 and $50 000/ QALY is 66% and 60%, respectively. Conclusions Outcomes from this study have demonstrated that the EPIC procedure may be a cost‐effective treatment strategy for ‘select’ patients with nasal polyposis. Data from this study were obtained from a small pilot trial, and we feel the results warrant a future randomised controlled trial to strengthen the outcomes.