Background: Dupilumab is a novel monoclonal antibody that recently received US Food and Drug Administration approval for the treatment of chronic rhinosinusitis with nasal polyps. Endoscopic sinus surgery (ESS) has been the mainstay of treatment for patients refractory to initial medical therapy. Data comparing the cost-effectiveness of these treatments are scarce. The objective of this study is to compare the cost-effectiveness of dupilumab and ESS treatment for patients with chronic rhinosinusitis with nasal polyps refractory to medical therapy. Methods: A cohort-style Markov decision tree economic evaluation with 10year time horizon was performed. The two comparative treatment strategies were dupilumab therapy or ESS followed by postoperative maintenance therapy. Patients with response to treatment continued with either maintenance or dupilumab therapy; patients with no response underwent ESS. The primary outcome measure was incremental cost per quality-adjusted life-year calculated from Sino-Nasal Outcome Test (SNOT-22) scores. Sensitivity analyses were performed including discounting scenarios and a probabilistic sensitivity analysis.

Background Treatment of aspirin-exacerbated respiratory disease AERD includes endoscopic sinus surgery ESS and aspirin desensitization AD with aspirin therapy a er desensitization ATAD The objective of this study was to determine the rate of major complications associated with aspirin use that resulted in the discontinuation of aspirin therapy Methods This study was a retrospective chart review of patients with AERD who underwent ESS AD and ATAD at a single AERD tertiary center between July and February Complications associated with aspirin that resulted in the discontinuation of aspirin therapy were analyzed via analysis of variance and logistic regression Results In total AERD patients underwent ESS with subsequent AD Ten patients discontinued therapy a er AD before starting ATAD Eight patients discontinued therapy a er starting ATAD There were patients with no complications throughout ATAD Reasons for discontinuation included gastritis upper gastrointestinal GI bleed anaphylaxis persistent sinonasal symptoms recurrent epistaxis asthma exacerbation and a nummular rash There was no significant correlation between complication rate and aspirin doses analysis of variance ANOVA F p = gender odds ratio OR confidence interval CI to p = age OR CI to p = or race/ethnicity OR CI to p = Conclusion AD with ATAD was associated with only a incidence of a clinically significant GI bleed and only a incidence of anaphylaxis A remaining patients discontinued aspirin therapy due to minor clinical sequelae These findings demonstrate that the majority of AERD patients tolerate AD with ATAD without any major complications © 2020 ARS-AAOA, LLC.

Background High‐dose, high‐volume steroid nasal irrigations (NSI) have been incorporated into the medical management of recalcitrant CRS, primarily following surgical intervention. The objective of this study was to evaluate the role of NSI as a preoperative management and to identify the percentage of patients who ultimately underwent ESS for recalcitrant CRS despite being on NSI. Methods Retrospective chart review of patients presenting with CRS who underwent a trial of NSI for at least six weeks. Pre‐irrigation and post‐irrigation outcomes measured included Lund‐Mackay scores (LMS), SNOT‐22 scores, and whether or not the patient underwent ESS. Results Of the 90 patients who underwent NSI, 32 patients underwent ESS, while 58 patients had a significant enough improvement in symptoms to avoid ESS. The likelihood of decision for surgery did not differ between the mometasone and budesonide groups (p=0.3094), comorbid asthma status (p=0.3585), smoking status (p=0.2256), polyp status (p=0.7288), or history of prior ESS (p=0.5803). SNOT scores significantly improvement following NSI in the group of patients that did not go on to ESS (p<0.0001) and in the group that did (p<0.0001). LMS also improved following NSI, but this was only statistically significant in the patients that ultimately went on to ESS (p=0.0102). Conclusions After a trial of NSI, 64.4% of patients with CRS no longer met candidacy for ESS and had a significant improvement in SNOT‐22 scores. This supports the use of nasal steroid irrigations in the medical management of CRS with and without surgical intervention and with and without nasal polyposis. This article is protected by copyright. All rights reserved