Long-Term Cost Utility Analysis of Endoscopic Sinus Surgery for Chronic Rhinosinusitis: Analysis of Five-Year Outcomes

Sunday, September 29, 2024

1:12 PM – 1:18 PM EDT

Location: MBCC, 230

Disclosure(s):

Dara R. Adams, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Ralph B. Metson, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

George A. Scangas, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Both endoscopic sinus surgery (ESS) and medical management have shown effectiveness for chronic rhinosinusitis (CRS); however, the majority of analyses have relied on short-term surgical outcomes. We aimed to evaluate the long-term (5-year) cost-effectiveness of ESS versus medical management for patients with CRS.

Methods: A cohort of 96 CRS patients who underwent ESS were compared with a 2 to 1 matched cohort of 48 CRS patients who were treated with medical management (saline irrigations, steroid sprays, antihistamines, steroid irrigations, and/or oral antibiotics). Long-term utility scores were calculated from the EuroQol 5-Dimension (EQ-5D) survey at 5-year follow up for the surgical cohort and 1-2 year follow up for the medical management cohort. Decision-tree analysis and a 10-state Markov model utilized published event probabilities and primary data to calculate long-term costs and utility over a 33 year time horizon. The primary outcome measure was incremental cost per quality-adjusted life year (QALY), which is expressed as an Incremental Cost Effectiveness Ratio. One-way and probabilistic sensitivity analyses were performed.

Results: The ESS strategy cost $63,296.10 and produced 22.61 QALYs. The medical management strategy cost $26,990.27 and produced 13.48 QALYs. The incremental cost-effectiveness ratio (ICER) for ESS versus medical therapy alone was $3,978.69 per QALY.

Conclusions: This study shows ESS to be a cost-effective intervention compared to medical therapy alone for the management of patients with CRS based on analysis evaluating long-term (5-year) surgical outcomes.

Presenting Author(s)

Dara R. Adams, MD

Assistant Professor of Otolaryngology - Head and Neck Surgery
University of Illinois At Chicago OTO-HNS Dept (M/C 648)
Chicago, IL, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

KT

Katherine Tashman

Harvard Medical School, Massachusetts, United States

Disclosure information not submitted.
Ralph B. Metson, MD

Professor of Otolaryngology
Mass Eye and Ear/Harvard Medical School
Boston, MA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

GS

George A. Scangas, MD

Assistant Professor of Otolaryngology
Harvard Medical School
Lynnfield, MA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.