title: Patient level decision making in recurrent acute rhinosinusitis: a cost-benefit threshold for surgery.
abstract: OBJECTIVE
  A previous effort to identify the threshold for surgery in recurrent acute rhinosinsutis (RARS) was made based on workforce productivity. While this macroeconomic approach is useful for population-level decision making, patient-level decision making is variable and driven by personal and financial implications. This microeconomic study seeks to identify threshold levels of infection where surgery becomes worthwhile to patients based on costs, lost income, and quality of life.
  
  
  METHODS
  Cost-Benefit Breakeven Analysis.
  
  
  METHODS
  A breakeven analysis was constructed from literature reported medical and surgical response rates, change in quality of life as a result of intervention, and costs to patients.
  
  
  RESULTS
  A breakeven threshold occurs when patients suffer from 1.3-2.8 episodes per year under the conservative assumption that the effects of surgery do not extend beyond 19 months--the longest outcomes reported.
  
  
  CONCLUSIONS
  Due to possible confusion with URTIs, we have adopted an approach similar to that advocated by the Rhinosinusitis Task Force. Given the average number of URTIs suffered by adults annually is 1.4-2.3. We suggest adding this to the threshold number of episodes calculated in the present model. Under the most conservative assumptions, this suggests that patients should consider surgery when suffering from five or more episodes per year.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. randy.leung@utoronto.ca
authors.forename: Randy
authors.initials: R
authors.lastname: Leung
authors.forename: Stella
authors.initials: S
authors.lastname: Almassian
authors.forename: Robert
authors.initials: R
authors.lastname: Kern
authors.forename: David
authors.initials: D
authors.lastname: Conley
authors.forename: Bruce
authors.initials: B
authors.lastname: Tan
authors.forename: Rakesh
authors.initials: R
authors.lastname: Chandra
mesh_terms: D000208:Acute Disease; D003362:Cost-Benefit Analysis; D003657:Decision Making; D006801:Humans; D011788:Quality of Life; D012008:Recurrence; D012220:Rhinitis / Q000191:economics / Q000601:surgery*; D012720:Severity of Illness Index; D012852:Sinusitis / Q000191:economics / Q000601:surgery*