title: Economic evaluation of endoscopic sinus surgery versus continued medical therapy for refractory chronic rhinosinusitis.
abstract: OBJECTIVE
  To evaluate the long-term cost-effectiveness of endoscopic sinus surgery (ESS) compared to continued medical therapy for patients with refractory chronic rhinosinusitis (CRS).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Luke
authors.initials: L
authors.lastname: Rudmik
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Soler
authors.forename: Jess C
authors.initials: JC
authors.lastname: Mace
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Schlosser
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
mesh_terms: D000305:Adrenal Cortex Hormones / Q000191:economics* / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D002908:Chronic Disease; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D003663:Decision Trees; D016527:Drug Costs / Q000706:statistics & numerical data; D004724:Endoscopy / Q000191:economics*; D006801:Humans; D007359:Insurance, Surgical / Q000191:economics; D008390:Markov Chains; D018803:Models, Economic; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D019057:Quality-Adjusted Life Years; D012220:Rhinitis / Q000191:economics* / Q000601:surgery*; D012852:Sinusitis / Q000191:economics* / Q000601:surgery*; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents
keywords: Chronic rhinosinusitis; Markov; cost effectiveness; decision tree; economic evaluation; endoscopic sinus surgery; medical therapy; sinusitis