Economic evaluation of endoscopic sinus surgery versus continued medical therapy for refractory chronic rhinosinusitis

Luke Rudmik, Zachary M. Soler, Jess C. Mace, Rodney J. Schlosser, Timothy L. Smith

Research output: Contribution to journalArticle

60 Scopus citations

Abstract

Objectives/Hypothesis: To evaluate the long-term cost-effectiveness of endoscopic sinus surgery (ESS) compared to continued medical therapy for patients with refractory chronic rhinosinusitis (CRS).

Study Design: Cohort-style Markov decision-tree economic evaluation.

Methods: The economic perspective was the U.S. third-party payer with a 30-year time horizon. The two comparative treatment strategies were: 1) ESS, followed by appropriate postoperative medical therapy; and 2) continued medical therapy alone. Primary outcome was the incremental cost per quality-Adjusted life year (QALY). Costs were discounted at a rate of 3.5% in the reference case. Multiple sensitivity analyses were performed, including differing time-horizons, discounting scenarios, and a probabilistic sensitivity analysis (PSA).

Results: The reference case demonstrated that the ESS strategy cost a total of $48,838.38 and produced a total of 20.50 QALYs. The medical therapy alone strategy cost a total of $28,948.98 and produced a total of 17.13 QALYs. The incremental cost effectiveness ratio for ESS versus medical therapy alone is $5,901.90 per QALY. The cost-effectiveness acceptability curve from the PSA demonstrated that there is a 74% certainty that the ESS strategy is the most cost-effective decision for any willingness to pay a threshold greater than $25,000. The time-horizon analysis suggests that ESS becomes the cost-effective intervention within the third year after surgery.

Results: The reference case demonstrated that the ESS strategy cost a total of $48,838.38 and produced a total of 20.50 QALYs. The medical therapy alone strategy cost a total of $28,948.98 and produced a total of 17.13 QALYs. The incremental cost effectiveness ratio for ESS versus medical therapy alone is $5,901.90 per QALY. The cost-effectiveness acceptability curve from the PSA demonstrated that there is a 74% certainty that the ESS strategy is the most cost-effective decision for any willingness to pay a threshold greater than $25,000. The time-horizon analysis suggests that ESS becomes the cost-effective intervention within the third year after surgery.

Original languageEnglish (US)
Pages (from-to)25-32
Number of pages8
JournalLaryngoscope
Volume125
Issue number1
DOIs
StatePublished - Jan 1 2015

Keywords

  • Chronic rhinosinusitis
  • Cost effectiveness
  • Decision tree
  • Economic evaluation
  • Endoscopic sinus surgery
  • Markov
  • Medical therapy
  • Sinusitis

ASJC Scopus subject areas

  • Otorhinolaryngology

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