Chu Matthew M, Garcia Jack T, Sedaghat Ahmad R, Scangas George A, Phillips Katie M
Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
Int Forum Allergy Rhinol. 2025 Feb;15(2):109-119. doi: 10.1002/alr.23452. Epub 2024 Sep 20.
The management of acute exacerbations of chronic rhinosinusitis (AECRS) is understudied and the most cost-effective management of AECRS has not been previously investigated. The aim of this study is to determine the most cost-effective strategy for the initial management of AECRS.
The study design consisted of a decision-tree economic model comparing three different initial strategies for managing a patient perceived AECRS: observation, upfront rescue medications, or clinic visit with diagnostic nasal endoscopy (DNE). The primary study outcome was the disease burden of a single AECRS, which was determined by the health utility value and the duration of symptoms. Strategies with an incremental cost-effectiveness ratio < $50,000/quality-adjusted life year (QALY) or equivalently < $137/quality-adjusted life day (QALD) were considered cost-effective.
Observation was the most cost-effective strategy at a willingness to pay of $137 per QALD. One-way sensitivity analysis demonstrated that observation was more effective than upfront rescue medications when the probability of bacterial infection as the cause of AECRS was <24.0%. Upfront rescue medications wer more cost effective than observation when the probability of bacterial infection exceeded 49.0%. Clinic visit with DNE was the most effective strategy to manage an AECRS, but it was not considered cost-effective.
Observation is the most cost-effective strategy for the initial management of AECRS when there is a low likelihood of bacterial infection. When the probability of bacterial etiology of AECRS exceeds 49.0%, upfront rescue medications proved to be the most cost-effective strategy.
慢性鼻 - 鼻窦炎急性加重（AECRS）的管理研究不足，且此前尚未对AECRS最具成本效益的管理方法进行过调查。本研究的目的是确定AECRS初始管理的最具成本效益的策略。
研究设计包括一个决策树经济模型，该模型比较了管理疑似AECRS患者的三种不同初始策略：观察、预先使用急救药物或进行诊断性鼻内镜检查（DNE）的门诊就诊。主要研究结果是单次AECRS的疾病负担，由健康效用值和症状持续时间决定。增量成本效益比<50,000美元/质量调整生命年（QALY）或等效地<137美元/质量调整生命日（QALD）的策略被认为具有成本效益。
在每QALD支付意愿为137美元时，观察是最具成本效益的策略。单向敏感性分析表明，当AECRS由细菌感染引起的概率<24.0%时，观察比预先使用急救药物更有效。当细菌感染概率超过49.0%时，预先使用急救药物比观察更具成本效益。进行DNE的门诊就诊是管理AECRS最有效的策略，但不被认为具有成本效益。
当细菌感染可能性较低时，观察是AECRS初始管理中最具成本效益的策略。当AECRS由细菌病因引起的概率超过49.0%时，预先使用急救药物被证明是最具成本效益的策略。
