title: A comparison of external and endonasal dacryocystorhinostomy in regard to patient satisfaction and cost.
abstract: BACKGROUND
  Definitive treatment of nasolacrimal duct obstruction is with external or endonasal dacryocystorhinostomy (DCR). Recent trials suggest surgical equivalency between techniques. We sought to compare alternative outcomes of DCR techniques in terms of quality of life and cost.
  
  
  METHODS
  This study was a multicentre prospective nonrandomized case series comparing adult patients treated with external or endonasal DCR. Groups were allocated according to DCR technique. Participation did not affect treatment choice. The Glasgow Benefit Inventory (GBI) was utilized to compare postoperative quality of life, and an activity-based costing (ABC) method used to estimate costs of the two techniques. Surgical data were also collected. A minimum of 3 months follow-up was observed.
  
  
  RESULTS
  Seventy-seven patients were included--37 external and 40 endonasal. Both techniques resulted in positive health status change, with mean GBI scores of +16.1 for external DCR and +24.1 for endonasal (p = 0.18). Using an ABC method, the operative costs of external DCR were less than endonasal at $715.79 AUD and $932.52 AUD respectively.
  
  
  CONCLUSIONS
  This trial suggests that external and endonasal DCR produce comparable outcomes in terms of postoperative quality of life, with external DCR resulting in lower operative costs.
authors.affiliation: Department of Ophthalmology, Alfred Hospital, Prahran, Australia. belinda.hii@gmail.com
authors.forename: Belinda W
authors.initials: BW
authors.lastname: Hii
authors.forename: Alan A
authors.initials: AA
authors.lastname: McNab
authors.forename: Justin D
authors.initials: JD
authors.lastname: Friebel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003608:Dacryocystorhinostomy / Q000191:economics* / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007767:Lacrimal Duct Obstruction / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome