Scangas George A, Remenschneider Aaron K, Su Brooke M, Shrime Mark G, Metson Ralph
Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
Laryngoscope. 2017 Jan;127(1):29-37. doi: 10.1002/lary.26169. Epub 2016 Jul 21.
To evaluate the cost-effectiveness of endoscopic sinus surgery (ESS) compared to medical therapy for patients with chronic rhinosinusitis (CRS) with and without nasal polyposis (NP).
Cohort-style Markov decision-tree economic model with a 36-year time horizon.
Two cohorts of 229 CRS patients with and without NP who underwent ESS were compared with a matched cohort of 229 CRS patients from the Medical Expenditures Survey Panel database (Agency for Healthcare Research and Quality, Rockville, MD) who underwent medical management. Utility scores were calculated from sequential patient responses to the EuroQol five-dimensions questionnaire. 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 was the incremental cost per quality-adjusted life year (QALY). Thorough sensitivity analyses were performed.
The reference case for CRS with NP yielded an incremental cost-effectiveness ratio (ICER) for ESS versus medical therapy of $5,687.41/QALY. The reference case for CRS without NP yielded an ICER of $5,405.44/QALY. The cost-effectiveness acceptability curve in both cases demonstrated 95% certainty that the ESS strategy was the most cost-effective option at a willingness-to-pay threshold of $20,000/QALY or higher. These results were robust to one-way and probabilistic sensitivity analysis.
This study demonstrates the cost-effectiveness of ESS compared to medical therapy alone for the management of CRS patients both with and without NP. The presence of nasal polyps was not found to affect the overall cost-effectiveness of ESS.
2C. Laryngoscope, 127:29-37, 2017.
评估与药物治疗相比，内镜鼻窦手术（ESS）对伴有和不伴有鼻息肉（NP）的慢性鼻窦炎（CRS）患者的成本效益。
具有36年时间跨度的队列式马尔可夫决策树经济模型。
将229例接受ESS的伴有和不伴有NP的CRS患者队列与来自医疗支出调查小组数据库（医疗保健研究与质量局，马里兰州罗克维尔）的229例接受药物治疗的匹配CRS患者队列进行比较。效用评分由患者对欧洲五维健康量表问卷的连续回答计算得出。决策树分析和十状态马尔可夫模型利用已发表的事件概率和原始数据来计算长期成本和效用。主要结局是每质量调整生命年（QALY）的增量成本。进行了全面的敏感性分析。
伴有NP的CRS参考病例中，ESS与药物治疗相比的增量成本效益比（ICER）为5687.41美元/QALY。不伴有NP的CRS参考病例的ICER为5405.44美元/QALY。两种情况下的成本效益可接受性曲线均显示，在支付意愿阈值为20000美元/QALY或更高时，ESS策略有95%的确定性是最具成本效益的选择。这些结果对单向和概率敏感性分析具有稳健性。
本研究表明，与单纯药物治疗相比，ESS治疗伴有和不伴有NP的CRS患者具有成本效益。未发现鼻息肉的存在会影响ESS的总体成本效益。
2C。《喉镜》，2017年，第127卷，第29 - 37页。
