Javanbakht Mehdi, Saleh Hesham, Hemami Mohsen Rezaei, Branagan-Harris Michael, Boiano Margaret
Optimax Access UK Ltd, University of Southampton Science Park, Chilworth, Hampshire, UK.
Device Access UK Ltd, University of Southampton Science Park, Chilworth, Hampshire, UK.
Pharmacoecon Open. 2020 Dec;4(4):679-686. doi: 10.1007/s41669-020-00198-8.
Chronic rhinosinusitis (CRS) is one of the commonest chronic health problems among adults in the UK. Around 15% of CRS patients undergo functional endoscopic sinus surgery (FESS) annually after failing medical treatment. However, as incomplete resolution of symptoms or complications post-operatively is common, the post-operative management is considered to be as important as the surgery itself. A bioabsorbable corticosteroid-eluting sinus implant (CESI) (Propel, mometasone furoate 370 µg) has been used as an alternative post-FESS treatment.
The objective of this study was to assess the cost effectiveness of the corticosteroid-eluting implant versus non-corticosteroid-eluting spacer following FESS for treatment of patients with CRS.
A decision tree model was developed to estimate the cost and effectiveness in each strategy. Costs and effects were estimated from a UK National Health Service (NHS) and personal social services perspective over a 6-month time horizon. Model pathways and parameters were informed by existing clinical guidelines and literature and sensitivity analyses were conducted to explore uncertainties in base-case assumptions.
Over a 6-month time horizon, inserting CESI at the end of FESS is less costly (£4646 vs. £4655 per patient) and is the more effective intervention [total quality-adjusted life-years (QALYs) over 6 months 0.443 vs. 0.444] than non-corticosteroid-eluting spacers; hence, it is a dominant strategy. The probabilistic analysis results indicate that CESI following FESS has a 62% probability of being cost effective at the £20,000/per QALY willingness-to-pay threshold and 56% probability of being a cost-saving intervention.
The use of CESI after FESS results in fewer post-operative complications than non-corticosteroid-eluting implants and may be a cost-saving technology over a 6-month time horizon. Although the cost of initial treatment with the CESI is greater, cost savings are made due to a reduction in the number of complications experienced.
慢性鼻-鼻窦炎（CRS）是英国成年人中最常见的慢性健康问题之一。约15%的CRS患者在药物治疗失败后每年接受功能性鼻内镜鼻窦手术（FESS）。然而，由于术后症状未完全缓解或出现并发症很常见，术后管理被认为与手术本身同样重要。一种可生物吸收的皮质类固醇洗脱鼻窦植入物（CESI）（Propel，糠酸莫米松370µg）已被用作FESS后的替代治疗方法。
本研究的目的是评估FESS术后皮质类固醇洗脱植入物与非皮质类固醇洗脱间隔物治疗CRS患者的成本效益。
建立决策树模型以估计每种策略的成本和效果。从英国国家医疗服务体系（NHS）和个人社会服务的角度，在6个月的时间范围内估计成本和效果。模型路径和参数参考了现有临床指南和文献，并进行了敏感性分析以探索基线假设中的不确定性。
在6个月的时间范围内，FESS结束时插入CESI的成本更低（每位患者4646英镑 vs. 4655英镑），并且比非皮质类固醇洗脱间隔物更有效[6个月内的总质量调整生命年（QALY）为0.443 vs. 0.444]；因此，它是一种占优策略。概率分析结果表明，FESS后使用CESI在每QALY支付意愿阈值为20000英镑时有62%的概率具有成本效益，并具有56%的概率成为成本节约型干预措施。
FESS后使用CESI导致的术后并发症比非皮质类固醇洗脱植入物少，并且在6个月的时间范围内可能是一种节约成本的技术。虽然CESI初始治疗的成本更高，但由于并发症数量减少而实现了成本节约。
