title: Cost utility analysis of endoscopic sinus surgery for chronic rhinosinusitis.
abstract: The purpose of this work was to evaluate the cost-effectiveness of endoscopic sinus surgery (ESS) compared to medical therapy for patients with chronic rhinosinusitis (CRS).
  
  
  
  The study design consisted of a microsimulation Markov decision-tree economic model with a 31-year time horizon. A cohort of 489 patients who underwent ESS for CRS were matched 1 to 1 with a cohort of 489 patients from the national Medical Expenditures Panel Survey database who underwent medical management for CRS. Utility scores were calculated from responses to the EuroQol 5-Dimension instrument in both cohorts. Decision-tree analysis and a subsequent 10-state Markov model utilized published event probabilities as well as primary data from a large multisurgeon prospective outcomes study to calculate long-term costs and utility. The primary outcome measure was incremental cost per quality-adjusted life year (QALY). Multiple sensitivity analyses were performed.
  
  
  
  The incremental cost-effectiveness ratio (ICER) for ESS vs medical therapy alone was $13,851.26 per QALY. The cost effectiveness acceptability curve demonstrated 85.84% and 98.69% certainty that the ESS strategy was the most cost-effective option at willingness-to-pay thresholds of $25,000 and $50,000 per QALY, respectively.
  
  
  
  This study shows ESS to be a cost-effective intervention compared to medical therapy alone for the management of patients with CRS.
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA.|Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA.
authors.forename: George A
authors.initials: GA
authors.lastname: Scangas
authors.affiliation: School of Medicine, University of California, San Francisco, San Francisco, CA.
authors.forename: Brooke M
authors.initials: BM
authors.lastname: Su
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA.|Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA.
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Remenschneider
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA.|Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA.|Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Shrime
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA.|Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Metson
mesh_terms: D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004724:Endoscopy / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D012220:Rhinitis / Q000191:economics* / Q000601:surgery; D012852:Sinusitis / Q000191:economics* / Q000601:surgery
keywords: chronic sinusitis; cost effectiveness; disease severity; endoscopic sinus surgery; evidence-based medicine; health care economics; health utility; patient reported outcomes; quality of life