Health utility outcomes in patients undergoing medical management for chronic rhinosinusitis: a prospective multiinstitutional study

Abstract

Background A health utility value represents an individual’s preference for living in a specific health state and is used in cost-utility analyses. This study investigates the impact of continuing medical therapy on health utility outcomes in patients with chronic rhinosinusitis (CRS). Methods The Medical Outcomes Study Short Form-6D (SF-6D) was administered to patients prospectively enrolled in a longitudinal study examining treatment outcomes for CRS. Patients were prescribed robust, initial medical therapy and then elected to continue with medical therapy (n=40) or undergo endoscopic sinus surgery (ESS), followed by medical therapy (n=152). Patients observed through treatment crossover to ESS were also evaluated (n=20). Health utility values (SF-6D) were generated at baseline, 6-months, and 12-months follow-up for both cohorts and evaluated using repeated measures ANOVA. Results Treatment crossover patients were found to have a significantly higher prevalence of previous sinus surgery compared to medical management (χ2=6.91; p=0.009) and surgical intervention (χ2=8.11; p=0.004) subgroups. Mean baseline utility value for the medical therapy cohort was significantly better compared to the ESS cohort (0.76[0.12] versus 0.70[0.15]; p=0.023). Significant improvement in health utility was reported in the ESS cohort (F(2)=37.69; p<0.001), while values remained stable, without significant improvement, in both the medical therapy cohort (F(2)=0.03; p=0.967) and treatment crossover cohort (F(2)=2.36; p=0.115). Conclusions Patients electing continued medical management report better baseline health utility compared to patients electing ESS. Patients electing ESS demonstrate significant improvement in health utility while those electing continued medical management demonstrate stable health utility over 12 months.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…1131,1148,1342,1343,1345 These benefits were reflected in substantially greater QoL improvements as well as decreased used of antibiotics, oral corticosteroids, and reduced absenteeism in the group treated surgically. 43,1131,1148,1342,1343,1345 Finally, a modeling based economic evaluation demonstrates that an ESS strategy has a higher probability of being the more cost-effective intervention in patients with refractory CRS compared to continuing with medical therapy alone. 1346 The most recent Cochrane review highlights the lack of high-quality RCTs, which are insufficient to draw firm conclusions.…”

“…46,49 Significant health utility improvements are seen with ESS and are comparable to those seen with joint replacement surgery and coronary angioplasty. 46,49,1340,1343 Comparative effectiveness studies of patients treated medically vs surgically can be divided into RCTs and real-world, nonrandomized observational comparison studies. A Cochrane Review in 2006 1130 based on 3 RCTs suggested that ESS did not offer additional benefit when compared to medical therapies.…”

Surgical Versus Medical Interventions in CRS and Nasal Polyps: Comparative Evidence Between Medical and Surgical Efficacy

“…Significant improvement was reported in the surgical group in SF-6D values between baseline and 6-month follow-up, in contrast to the medical management and crossover groups, which showed no significant differences [51].…”

“…Surgical patients reported greater improvements in disease-specific QOL measured by both the Chronic Sinusitis Survey and the Rhinosinusitis Disability Index [50] and had lower levels of ongoing antibiotic and steroid use and absenteeism [51]. Significant improvement was reported in the surgical group in SF-6D values between baseline and 6-month follow-up, in contrast to the medical management and crossover groups, which showed no significant differences [51].…”

“…Smith et al have undertaken a prospective multi-centered study comparing CRS patients undergoing medical versus surgical treatment [50][51][52]. Patients entered each arm of the trial based on their own preference, guided by their surgeons, and therefore, there is a risk of treatment selection bias.…”