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

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.