Cost-effectiveness analysis of endoscopic sinus surgery versus external approach for sinonasal inverted papilloma

Aim: Sinonasal inverted papilloma is a benign yet locally aggressive tumor with potential for recurrence. Surgical resection is the primary treatment, and both endoscopic sinus surgery (ESS) and external approaches are employed depending on tumor location and stage. While clinical outcomes of both techniques have been studied, their economic implications remain underexplored. Materials & methods: A retrospective cost-effectiveness analysis was conducted on 50 patients treated for histologically confirmed inverted papilloma between 1995 and 2018. Patients underwent either ESS or an external approach. Direct medical costs were calculated from hospital records, and effectiveness was measured by 5-year disease-free survival (DFS). Cost-minimization and cost-effectiveness analyses were performed, including subgroup evaluation by Krouse stage. Results: The median total cost was significantly lower for the endoscopic group (€7567.23) compared with the external group (€11,456.40; p = 0.018). Endoscopic surgery resulted in an average savings of approximately €4000 per patient over a 5-year period. In localized disease tumors (Krouse I-II), ESS was both less costly and equally effective. Although the external approach showed a slightly higher DFS (77.2 vs 67.8%), the incremental cost-effectiveness ratio (ICER) was €40,837.13, suggesting limited cost-justification for this benefit. Conclusion: Endoscopic surgery resulted in an average saving of approximately €4000 per patient over a 5-year period. While external approaches showed slightly better disease-free survival, the endoscopic technique proved significantly more cost-effective, offering a better balance between clinical outcomes and resource use.