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Endoscopic polypectomy in the clinic: a pilot cost-effectiveness analysis.

L Rudmik^1,2, K A Smith¹, S Kilty^3,4

¹Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.

Clinical Otolaryngology : Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery

|June 9, 2015

Summary

Endoscopic polypectomy in the clinic (EPIC) may be a cost-effective treatment for select chronic rhinosinusitis patients. This pilot study suggests EPIC is more affordable than endoscopic sinus surgery (ESS) with comparable outcomes.

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Area of Science:

Otolaryngology
Health Economics
Medical Technology Assessment

Background:

Chronic rhinosinusitis (CRS) with nasal polyposis significantly impacts patient quality of life.
Current treatment options include formal endoscopic sinus surgery (ESS), but cost-effectiveness data for newer procedures are needed.

Purpose of the Study:

To conduct a pilot economic evaluation comparing the cost-effectiveness of endoscopic polypectomy in the clinic (EPIC) versus ESS for select CRS patients.
To assess treatment strategies from a Canadian third-party payer perspective.

Main Methods:

A Markov decision tree model with a 30-year time horizon was utilized for cost-effectiveness analysis.
The model compared EPIC and ESS, discounting costs and effects at 3.5%.
Probabilistic sensitivity analysis was performed to evaluate the robustness of the findings.

Main Results:

Over 30 years, ESS was projected to cost $21,345 and yield 13.17 QALYs, while EPIC cost $5591 and yielded 12.93 QALYs.
The incremental cost-effectiveness ratio (ICER) for ESS versus EPIC was $65,641 per QALY.
EPIC demonstrated a 66% and 60% probability of being cost-effective at willingness-to-pay thresholds of $30,000 and $50,000 per QALY, respectively.

Conclusions:

The endoscopic polypectomy in the clinic (EPIC) procedure appears to be a potentially cost-effective treatment for select patients with nasal polyposis.
Further randomized controlled trials are warranted to validate these preliminary findings from the pilot study.