Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.
Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.
Laryngoscope. 2021 Jan;131(1):E26-E33. doi: 10.1002/lary.28648. Epub 2020 Apr 3.
Both endoscopic sinus surgery (ESS) and biologic therapies have shown effectiveness for medically-refractory chronic rhinosinusitis with nasal polyps (CRSwNP) without severe asthma. The objective was to evaluate cost-effectiveness of dupilumab versus ESS for patients with CRSwNP.
Cohort-style Markov decision-tree economic model with a 36-year time horizon.
A cohort of 197 CRSwNP patients who underwent ESS were compared with a matched cohort of 293 CRSwNP patients from the SINUS-24 and SINUS-52 Phase 3 studies who underwent treatment with dupilumab 300 mg every 2 weeks. Utility scores were calculated from the SNOT-22 instrument in both cohorts. 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 measure was incremental cost per quality-adjusted life year (QALY), which is expressed as an Incremental Cost Effectiveness Ratio. One-way and probabilistic sensitivity analyses were performed.
The ESS strategy cost $50,436.99 and produced 9.80 QALYs. The dupilumab treatment strategy cost $536,420.22 and produced 8.95 QALYs. Because dupilumab treatment was more costly and less effective than the ESS strategy, it is dominated by ESS in the base case. One-way sensitivity analyses showed ESS to be cost-effective versus dupilumab regardless of the frequency of revision surgery and at any yearly cost of dupilumab above $855.
The ESS treatment strategy is more cost effective than dupilumab for upfront treatment of CRSwNP. More studies are needed to isolate potential phenotypes or endotypes that will benefit most from dupilumab in a cost-effective manner.
2C Laryngoscope, 131:E26-E33, 2021.
对于没有严重哮喘的药物难治性慢性鼻-鼻窦炎伴鼻息肉（CRSwNP），内镜鼻窦手术（ESS）和生物疗法均已显示出有效性。本研究旨在评估度伐鲁单抗对比 ESS 治疗 CRSwNP 的成本效益。
具有 36 年时间范围的队列式马尔可夫决策树经济模型。
对接受 ESS 的 197 例 CRSwNP 患者的队列进行研究，并与来自 SINUS-24 和 SINUS-52 三期研究中接受度伐鲁单抗 300mg 每 2 周治疗的 293 例 CRSwNP 患者的匹配队列进行比较。两组均使用 SNOT-22 量表计算效用得分。决策树分析和 10 状态 Markov 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。主要结局测量指标为每质量调整生命年（QALY）的增量成本，其表示为增量成本效果比。进行了单因素和概率敏感性分析。
ESS 策略的成本为 50436.99 美元，产生了 9.80 个 QALYs。度伐鲁单抗治疗策略的成本为 536420.22 美元，产生了 8.95 个 QALYs。由于度伐鲁单抗治疗比 ESS 策略更昂贵且效果更差，因此在基础情况下，它被 ESS 策略所主导。单因素敏感性分析表明，无论鼻窦再手术的频率如何，以及度伐鲁单抗的每年成本高于 855 美元，ESS 均比度伐鲁单抗更具成本效益。
对于 CRSwNP 的初始治疗，ESS 治疗策略比度伐鲁单抗更具成本效益。需要更多的研究来确定潜在的表型或内型，以便以具有成本效益的方式使度伐鲁单抗最受益。
2C Laryngoscope, 131:E26-E33, 2021.
