Cost-effectiveness of Endoscopic Polypectomy in Clinic compared to Endoscopic Sinus Surgery: A modelling study

Srishti Kumar; Kednapa Thavorn; Sasha van Katwyk; Andrea Lasso; Shaun J Kilty

doi:10.1111/coa.13533

Cost-effectiveness of Endoscopic Polypectomy in Clinic compared to Endoscopic Sinus Surgery: A modelling study

Clin Otolaryngol. 2020 Jul;45(4):477-485. doi: 10.1111/coa.13533. Epub 2020 Apr 26.

Authors

Srishti Kumar¹, Kednapa Thavorn^{1

2

3}, Sasha van Katwyk^{1

2}, Andrea Lasso¹, Shaun J Kilty^{1

4

5}

Affiliations

¹ Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
² School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
³ Institute of Clinical and Evaluative Sciences, University of Ottawa, Ottawa, ON, Canada.
⁴ Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.
⁵ Dr. S. Kilty Medicine Prof Corp, Ottawa, ON, Canada.

PMID: 32227591
DOI: 10.1111/coa.13533

Abstract

Objective: To compare costs and quality-adjusted life years of patients receiving endoscopic polypectomy in the clinic those receiving endoscopic sinus surgery from the perspective of Canada's health system.

Method: We developed a Markov model to simulate costs and quality-adjusted life years among a cohort of patients with chronic rhinosinusitis with polyps who received endoscopic polypectomy in clinic or endoscopic sinus surgery, over a patient's lifetime. Our study focused on patients with chronic rhinosinusitis with polyps who have the predominant symptom of bilateral nasal obstruction. Cost data were obtained from Canadian sources. Health utility values were derived from Sino-nasal Outcome Test (SNOT-22) scores reported in the published literature. A cycle length of six months was used. Both costs and quality-adjusted life years were discounted using an annual rate of 1.5%. We conducted one-way and probabilistic sensitivity analyses to assess the robustness of the study findings.

Results: Endoscopic polypectomy in clinic was a cost-saving option as it had a lower cost (C$736 vs. C$6,728) and produced more quality-adjusted life years (13.85 vs 13.06) compared to endoscopic sinus surgery. Our findings were, however, highly sensitive to health utility values. Results from probabilistic sensitivity analysis showed that endoscopic polypectomy in clinic had a lower cost and was more effective compared to endoscopic sinus surgery in 99.86% of iterations.

Conclusion: From the perspective of the publicly funded healthcare system, endoscopic polypectomy in clinic was economically attractive compared to endoscopic sinus surgery for chronic rhinosinusitis with polyps patients who have a primary symptom of bilateral nasal obstruction. The cost-effectiveness results are, however, highly dependent on the relative impact of endoscopic polypectomy in the clinic and endoscopic sinus surgery on post-surgery health utility values.

Keywords: chronic rhinosinusitis with polyps; cost-utility analysis; endoscopic polypectomy; endoscopic sinus surgery.

Publication types

Comparative Study

MeSH terms

Canada
Cost-Benefit Analysis
Endoscopy / economics*
Endoscopy / methods*
Female
Humans
Male
Markov Chains
Nasal Obstruction / surgery*
Nasal Polyps / surgery*
Quality-Adjusted Life Years*
Rhinitis / surgery*
Sinusitis / surgery*