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Cost-effectiveness Analysis of Inferior Turbinate Reduction and Immunotherapy in Allergic Rhinitis
Michael Yong1, Kaishan Aravinthan2, Keshinisuthan Kirubalingam3
1Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.
The Laryngoscope
|August 29, 2023
Summary
For allergic rhinitis with nasal obstruction, inferior turbinate reduction (ITR) before subcutaneous allergen immunotherapy (SCIT) is the most cost-effective strategy. This approach offers better value compared to other treatments for persistent symptoms.
Area of Science:
- Otolaryngology
- Allergy & Immunology
- Health Economics
Background:
- Allergic rhinitis (AR) frequently causes nasal obstruction due to atopic inferior turbinate hypertrophy (ITH).
- Current guidelines recommend subcutaneous allergen immunotherapy (SCIT) for pharmacologic treatment failures.
- The cost-effectiveness of inferior turbinate reduction (ITR) relative to other treatments remains unclear.
Purpose of the Study:
- To compare the cost-effectiveness of different treatment strategies for AR with nasal obstruction.
- To evaluate treatment sequences involving pharmacotherapy, allergy testing, SCIT, and ITR.
Main Methods:
- A 5-year cost-effectiveness analysis was performed.
- Four treatment combinations were compared: pharmacotherapy alone, SCIT, SCIT then ITR for non-responders, and ITR then SCIT for non-responders.
- Incremental cost-effectiveness ratios (ICERs) were calculated.
Main Results:
- Prioritizing ITR before SCIT emerged as the most cost-effective strategy for patients failing initial pharmacotherapy.
- Probabilistic sensitivity analysis confirmed this finding in 95.4% of scenarios.
- ITR demonstrated cost-effectiveness even when combined with septoplasty.
Conclusions:
- Inferior turbinate reduction (ITR) is a cost-effective treatment for AR patients with nasal obstruction due to ITH.
- ITR should be considered before pursuing immunotherapy for persistent symptoms.
- This strategy offers a valuable alternative to current treatment paradigms.
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