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

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. Conclusion: Results from this study suggest that employing an ESS treatment strategy is the most cost‐effective intervention compared to continued medical therapy alone for the long‐term management of patients with refractory CRS. Level of Evidence: N/A. Laryngoscope , 125:25–32, 2015