Rudmik Luke, Smith Timothy L
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA.
Otolaryngol Head Neck Surg. 2014 Aug;151(2):359-66. doi: 10.1177/0194599814533779. Epub 2014 May 5.
This study aimed to evaluate the cost-effectiveness of a mometasone steroid-eluting sinus implant compared to a nonsteroid-eluting sinus implant following endoscopic sinus surgery (ESS) for chronic rhinosinusitis.
Economic evaluation using a decision tree model.
Academic and nonacademic otolaryngology practices.
Patients with refractory chronic rhinosinusitis undergoing ESS.
The economic perspective was the health care third party payer. Effectiveness and probability data were obtained from a single meta-analysis of 2 randomized, double-blind, controlled trials. Costs were obtained from the Centers for Medicare & Medicaid Services database and wholesale pharmaceutical pricing. Multiple sensitivity analyses were performed including a probabilistic sensitivity analysis. Comparative treatment groups were (1) placement of the mometasone steroid-eluting sinus implant following ESS and (2) placement of a nonsteroid-eluting implant following ESS. The primary outcome was cost per postoperative intervention avoided within 60 days after ESS.
The mean cost for the steroid-eluting and nonsteroid-eluting sinus implant strategies were $1,572.91 and $365.18, respectively. The steroid-eluting strategy incremental cost-effectiveness ratio was $5,489.68. The sensitivity analysis demonstrated a 74.3%, 87.2%, and 90.5% certainty that the steroid-eluting implant strategy is cost-effective at willingness-to-pay thresholds of $10,000, $25,000, and $50,000, respectively.
Results from this economic evaluation suggest that placement of a mometasone steroid-eluting sinus implant into the ethmoid cavity following ESS for refractory chronic rhinosinusitis is a cost-effective intervention for preventing a postoperative intervention within 60 days after surgery.
本研究旨在评估与非类固醇洗脱鼻窦植入物相比，在慢性鼻窦炎的鼻内镜鼻窦手术（ESS）后使用莫米松类固醇洗脱鼻窦植入物的成本效益。
使用决策树模型进行经济评估。
学术性和非学术性耳鼻喉科诊所。
接受ESS的难治性慢性鼻窦炎患者。
从医疗保健第三方支付者的角度进行经济评估。有效性和概率数据来自对2项随机、双盲、对照试验的单一荟萃分析。成本数据来自医疗保险和医疗补助服务中心数据库以及药品批发价格。进行了多项敏感性分析，包括概率敏感性分析。比较治疗组为：（1）ESS后植入莫米松类固醇洗脱鼻窦植入物；（2）ESS后植入非类固醇洗脱植入物。主要结局是ESS后60天内避免的每次术后干预的成本。
类固醇洗脱和非类固醇洗脱鼻窦植入策略的平均成本分别为1572.91美元和365.18美元。类固醇洗脱策略的增量成本效益比为5489.68美元。敏感性分析表明，在支付意愿阈值分别为10000美元、25000美元和50000美元时，类固醇洗脱植入策略具有成本效益的确定性分别为74.3%、87.2%和90.5%。
这项经济评估的结果表明，对于难治性慢性鼻窦炎，在ESS后将莫米松类固醇洗脱鼻窦植入物植入筛窦腔是一种具有成本效益的干预措施，可预防术后60天内的再次干预。
