Long-Term Cost Utility Analysis of Endoscopic Sinus Surgery: Analysis of 5-Year Outcomes

Abstract

Objective: Both endoscopic sinus surgery (ESS) and medical management have shown effectiveness for treatment of chronic rhinosinusitis (CRS); however, the majority of such analyses have relied on short-term surgical outcomes. We aimed to evaluate the long-term (5-year) cost-effectiveness of ESS versus medical management for patients with CRS. Methods: A cohort-style Markov decision-tree economic model with a 33-year time horizon was developed. A cohort of 96 CRS patients who underwent ESS were compared with a 2 to 1 matched cohort of 48 CRS patients who were treated with medical management at the same academic medical center. Long-term utility scores were calculated from the EuroQol 5-Dimension (EQ-5D) survey at 5-year follow up for the surgical cohort and 1–2 year follow up for the medical management cohort. Decision-tree analysis and a 10-state Markov model utilized published event probabilities and primary data to calculate long-term costs and utility. The primary outcome measure was the incremental cost-effectiveness ratio (ICER), which represents incremental cost per quality-adjusted life year (QALY). Results: The ESS strategy cost more ($63,296.10) but yielded increased QALYs (22.61). In comparison, the medical management strategy cost $26,990.27 but yielded only 13.48 QALYs. The ICER for ESS versus medical therapy alone was $4367.68 per QALY. Conclusion: This study shows ESS to be a cost-effective intervention compared to medical therapy alone for the management of patients with CRS based on analysis evaluating long-term (5-year) surgical outcomes. Level of Evidence: N/A.