Establishing a threshold for surgery in recurrent acute rhinosinusitis: a productivity-based analysis

Area of Science:

• Otolaryngology
• Health Economics
• Medical Decision Making

Background:

• Recurrent acute rhinosinusitis (RARS) presents treatment challenges with medical and surgical options.
• Optimal timing for surgical intervention versus continued medical management remains unclear.
• Identifying a threshold for RARS episodes is crucial for guiding treatment decisions.

Purpose of the Study:

• To determine the breakeven point where surgical morbidity is offset by the morbidity of recurrent acute rhinosinusitis.
• To establish a quantitative threshold for recommending surgery in RARS patients based on infection frequency.

Main Methods:

• Health economic breakeven threshold analysis.
• Productivity modeling simulating 1-3 years post-surgery.
• Inclusion of literature-reported response rates, quality of life, and productivity data.

Main Results:

• Lost productivity suggests a breakeven threshold at 4 episodes of RARS per year (range: 1.8-12.8).
• Considering upper respiratory tract infections, a threshold of 6 episodes per year is proposed for surgical consideration.

Conclusions:

• Surgical intervention for RARS may be viable at 6 episodes per year, balancing productivity losses.
• The long-term benefits of surgery likely lower the true breakeven threshold.
• Patient-centered discussion should weigh disease burden, quality of life, and surgical risks.