title: Endoscopic polypectomy in the clinic: a pilot cost-effectiveness analysis.
abstract: OBJECTIVE
  The purpose of this pilot economic evaluation was to assess the cost-effectiveness of the endoscopic polypectomy in the clinic (EPIC) procedure compared to formal endoscopic sinus surgery (ESS) for the treatment of select chronic rhinosinusitis (CRS) patients with nasal polyposis.
  
  
  METHODS
  Cost-effectiveness analysis using a Markov decision tree model with a 30-year time horizon. The two comparative treatment groups were as follows: (i) EPIC and (ii) ESS. Costs and effects were discounted at a rate of 3.5%. A probabilistic sensitivity analysis was performed.
  
  
  METHODS
  Economic perspective of the Canadian government third-party payer.
  
  
  METHODS
  CRS patients with nasal polyposis who have predominantly isolated symptoms of nasal obstruction with or without olfactory loss.
  
  
  METHODS
  Incremental cost per quality adjusted life year (QALY).
  
  
  RESULTS
  Over a time period of 30 years, the reference case demonstrated that the ESS strategy cost a total of $21,345 and produced 13.17 QALYs while the EPIC strategy cost a total of $5591 and produced 12.93 QALYs. The ESS versus EPIC incremental cost-effectiveness ratio was $65,641/QALY. The probability that EPIC is cost-effective compared to ESS at a maximum willingness-to-pay threshold of $30,000 and $50,000/QALY is 66% and 60%, respectively.
  
  
  CONCLUSIONS
  Outcomes from this study have demonstrated that the EPIC procedure may be a cost-effective treatment strategy for 'select' patients with nasal polyposis. Data from this study were obtained from a small pilot trial, and we feel the results warrant a future randomised controlled trial to strengthen the outcomes.
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.|Institute of Public Health (IPH), University of Calgary, Calgary, AB, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Rudmik
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.
authors.forename: K A
authors.identifier: http://orcid.org/0000-0002-7026-5819
authors.initials: KA
authors.lastname: Smith
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.|Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada.
authors.forename: S
authors.identifier: http://orcid.org/0000-0003-1857-7628
authors.initials: S
authors.lastname: Kilty
mesh_terms: D002170:Canada; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004724:Endoscopy / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D009298:Nasal Polyps / Q000601:surgery*; D010865:Pilot Projects; D019057:Quality-Adjusted Life Years; D012220:Rhinitis / Q000601:surgery*; D012720:Severity of Illness Index; D012852:Sinusitis / Q000601:surgery*