Health utility outcomes in patients undergoing medical management for chronic rhinosinusitis: a prospective multiinstitutional study
Open accessAbstract
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.
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Endoscopic surgical treatment is beneficial in patients with chronic rhinosinusitis with nasal polyps who have severe symptoms and do not respond to appropriate medical treatment.
“In CRS with NP , endoscopic surgical treatment has been shown to be beneficial in patients with severe symptoms who do not respond to appropriate medical treatment [20,127,128,212-218] and may be more cost-effective [219,220].”
From Position Paper on Nasal Obstruction: Evaluation and Treatment (2018) · cites this paper as [212]
The Results and Discussion (page not available in our copy) report significantly improved health utility after endoscopic sinus surgery in patients with medically refractory CRS; the surgical group also had worse baseline health utility. The reported surgical benefit is for CRS overall, however, not specifically for patients with nasal polyps and severe symptoms. (LLM, conf=0.87)
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Poetker, D. M. (2015) · International Forum of Allergy & Rhinology · doi:10.1002/alr.21676
DİLEK, D., Kar, M., & Bedrosian, J. C. (2023) · Springer eBooks · doi:10.1007/978-3-031-22483-6_16-1
41 Clinical Outcomes in the Treatment of Chronic RhinosinusitisChronic rhinosinusitis (CRS)
(2025) · Thieme Medical Publishers eBooks · doi:10.1055/b-0045-211996
13 Health Impact of RhinosinusitisRhinosinusitis, health impact of
(2025) · Thieme Medical Publishers eBooks · doi:10.1055/b-0045-211968
- Authors
- Luk, L. J., Steele, T. O., Mace, J. C., Soler, Z. M., Rudmik, L., & Smith, T. L.
- Affiliations
- Oregon Health & Science University (US)
- Medical University of South Carolina (US)
- University of Calgary (CA)
- Corresponding author
- Smith, Timothy L.
- Venue
- International Forum of Allergy & Rhinology
- Publisher
- Wiley
- Published
- 2015-07-03
- Volume
- 5
- Issue
- 11
- Pages
- 1018-1027
- ISSN
- 2042-6976 (ISSN-L)
- 2042-6984
- PMC
- PMC4698367
- OpenAlex
- W1481301014
- Cited by
- 48
- References
- 43
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 5 · 2022: 2 · 2021: 5 · 2020: 6 · 2019: 2 · 2018: 4 · 2017: 3 · 2016: 11 · 2015: 5
- FWCI
- 6.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Forum of Allergy & Rhinology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (DC005805)
- Topics
- Health Sciences › Medicine › Otorhinolaryngology › Sinusitis and nasal conditions
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Keywords
- chronic rhinosinusitis, health-related quality of life, health utility, SF-6D, medical management, endoscopic sinus surgery, treatment crossover, cost-utility analysis, sinus surgery
- MeSH terms
- Adult, Aged, Chronic Disease, Costs and Cost Analysis, Female, Follow-Up Studies, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Prospective Studies, Quality of Life, Surveys and Questionnaires, Rhinitis, Sinusitis
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