Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Clin Otolaryngol. 2020 Jul;45(4):477-485. doi: 10.1111/coa.13533. Epub 2020 Apr 26.
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.
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.
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.
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.
从加拿大卫生系统的角度比较门诊内镜息肉切除术和内镜鼻窦手术患者的成本和质量调整生命年。
我们开发了一个马尔可夫模型，以模拟一组患有双侧鼻塞为主要症状的慢性鼻-鼻窦炎伴鼻息肉患者在其一生中接受门诊内镜息肉切除术或内镜鼻窦手术的成本和质量调整生命年。我们的研究重点是患有双侧鼻塞为主要症状的慢性鼻-鼻窦炎伴鼻息肉患者。成本数据来自加拿大来源。健康效用值源自已发表文献中报告的 Sino-nasal Outcome Test（SNOT-22）评分。使用 6 个月的周期长度。使用 1.5%的年贴现率对成本和质量调整生命年进行贴现。我们进行了单因素和概率敏感性分析，以评估研究结果的稳健性。
门诊内镜息肉切除术具有成本效益，因为它的成本较低（736 加元 vs. 6728 加元），且产生的质量调整生命年更多（13.85 年 vs. 13.06 年）。然而，我们的研究结果对健康效用值非常敏感。概率敏感性分析结果表明，在 99.86%的迭代中，与内镜鼻窦手术相比，门诊内镜息肉切除术的成本更低，且更有效。
从公共资助的医疗保健系统的角度来看，对于双侧鼻塞为主要症状的慢性鼻-鼻窦炎伴鼻息肉患者，与内镜鼻窦手术相比，门诊内镜息肉切除术具有经济吸引力。然而，成本效益结果高度依赖于门诊内镜息肉切除术和内镜鼻窦手术对术后健康效用值的相对影响。
