title: Budget impact analysis of bioabsorbable drug-eluting sinus implants following endoscopic sinus surgery.
abstract: OBJECTIVE
  Propel is a bioabsorbable drug-eluting sinus implant inserted following an endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). The objective of this study was to estimate the budget impact of incorporating Propel post-ESS for CRS patients from a self-insured employer or third-party payer perspective.
  
  
  METHODS
  An Excel-based budget impact model was developed. Estimates of the prevalence of CRS, rates of ESS, and effectiveness outcomes, along with direct and indirect costs from CRS were obtained from published literature. A total population of 1.5 million members was hypothesized for the analysis. All cost data were adjusted to October 2015 US dollars using the Medical Care Component of the Consumer Price Index. The cost and clinical/economic characteristics of Propel were compared to other treatments commonly used to minimize post-operative complications. The primary outcome was the incremental budget impact reported using per-member-per-month (PMPM) costs. Scenario-based, probabilistic, and one-way sensitivity analyses were performed to gauge the robustness of the results and identify the parameters with the most influence on the results.
  
  
  RESULTS
  For a US self-insured employer or a commercial health plan of 1.5 million members, the incremental PMPM impact of incorporating Propel was estimated to range from -$0.003 to $0.036, respectively, for all members in the health plan. Sensitivity analyses identified the cost of Propel, probability of polyposis recurrence requiring medical intervention, probability of adhesion formation requiring surgical intervention, and the treatment costs for polyposis as the primary parameters influencing the results.
  
  
  CONCLUSIONS
  This study has demonstrated the use of Propel following ESS procedures has a negligible impact on the budget of a US self-insured employer or payer. The upfront cost of Propel was offset by savings associated with reduced probability for polyp recurrence, adhesion formation, and their subsequent treatment.
authors.affiliation: a Department of Preventive Medicine & Department of Economics , Stony Brook University , Stony Brook , NY , USA ;
authors.forename: John A
authors.initials: JA
authors.lastname: Rizzo
authors.affiliation: b 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.affiliation: c Health Outcomes Research, CTI Clinical Trial and Consulting Services, Inc. , Cincinnati , OH , USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mallow
authors.affiliation: c Health Outcomes Research, CTI Clinical Trial and Consulting Services, Inc. , Cincinnati , OH , USA.
authors.forename: Swetha R
authors.initials: SR
authors.lastname: Palli
mesh_terms: D020341:Absorbable Implants / Q000191:economics*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D054855:Drug-Eluting Stents / Q000191:economics*; D004724:Endoscopy / Q000379:methods; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007343:Insurance Carriers / Q000191:economics*; D017059:Models, Econometric; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D012008:Recurrence; D012852:Sinusitis / Q000601:surgery*
keywords: Bioabsorbable steroid-eluting; Budget impact; Chronic rhinosinusitis; Economic evaluation; Endoscopic sinus surgery; Propel; Stent