Economic analysis of surgery and biological therapy for chronic rhinosinusitis with nasal polyps

Chronic rhinosinusitis with nasal polyps (CRSwNP) imposes major health and economic burdens. Endoscopic sinus surgery (ESS) and biologic therapy are treatment options. This study compares their effectiveness and cost-efficiency from the Spanish National Health System (NHS) perspective.

An economic evaluation was conducted in severe CRSwNP, following Spanish-NHS guidelines. Data came from a tertiary-hospital with 10-year projections. Effectiveness was measured as reduction in the Sinonasal Outcome Test-22 (SNOT-22). Cost-utility analysis used quality-adjusted life years (QALYs). Micro-costing was applied for ESS, while annual drug costs were considered for biologics. Sensitivity analyses tested robustness.

89 patients were included (63 ESS, 26 biologics). After 2-years, both strategies achieved similar SNOT-22 improvements (-31.8 ESS, -31.0 biologics). Costs were far lower for ESS (EUR 5,302.78) than biologics (EUR 27,198.23), making biologics less efficient despite comparable benefit. The 2-year incremental cost-utility ratio (ICUR) for biologics was EUR 1.2 million/QALY, above accepted thresholds. At 10-years, biologics yielded 2.75 QALYs at an incremental cost of EUR 108,917.62 (ICUR EUR 39,592/QALY). Sensitivity ana-lyses showed that biologics generally remained above commonly accepted willingness-to-pay thresholds, although substantial price reductions (up to 40%) allowed ICURs to approach the upper limit of acceptability.

Both treatments provide meaningful improvement. ESS remained the less costly strategy and was more efficient over the short term, whereas long-term projections showed higher QALY gains with biologics at substantially greater cost. Within Spanish- NHS, biologics may approach cost-effectiveness only under favorable pricing assumptions and should be reserved for patients with contraindications or persistent disease after ESS.