Upfront Draf III Strategy Often Less Costly for Severe CRS Requiring Surgery

Area of Science:

• Otolaryngology
• Surgical Oncology
• Medical Economics

Background:

• Draf III procedures are perceived as more time- and supply-intensive than standard functional endoscopic sinus surgery (FESS).
• Quantifying the cost difference and identifying cost drivers is crucial for surgical decision-making.
• Understanding cost factors can optimize resource allocation in sinus surgery.

Purpose of the Study:

• To compare the costs of Draf III procedures versus standard FESS.
• To analyze the specific time- and supply-related cost factors contributing to the overall expense.
• To evaluate the cost-effectiveness of upfront Draf III versus staged approaches.

Main Methods:

• Retrospective analysis of inflammatory sinus surgeries at a tertiary care center (July 2021-July 2023).
• Review of patient factors and cost variables, including operating room time and supply costs.
• Multivariable analysis to identify significant cost determinants.

Main Results:

• Operating room and supply costs constituted 63.1% and 16.6% of total costs for Draf III procedures, respectively.
• The average total cost for standard FESS was $8960.31, compared to $10118.60 for full FESS with Draf III and $9414.29 for targeted revision Draf III.
• An upfront Draf III is more cost-effective than standard FESS with revision if the expected revision rate surpasses 12.3%.

Conclusions:

• Surgical costs for FESS with Draf III are predominantly driven by operating room time.
• The cost difference between a full Draf III and standard FESS or revision Draf III is not substantial.
• An upfront Draf III may be a more economical approach for patients with a high risk of recurrent frontal sinus disease.