Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost‐effectiveness

Abstract

Objective The objective of this study was to demonstrate how decision‐analytic modelling can help to determine circumstances under which surgery may become cost‐effective, using septoplasty as an example. Design We developed a decision‐analytic model comparing septoplasty to non‐surgical management for nasal obstruction in adults with a deviated septum. Based on the estimated cost difference between both treatments, we calculated the minimal (a) gain in quality‐adjusted life‐years, or (b) reduction in productivity losses needed for septoplasty to be cost‐effective. Input was derived from literature and publicly available data sources. The time horizon of our model was one year, and the willingness‐to‐pay per quality‐adjusted life‐year was €20 000, in accordance with current guidelines. Results The cost difference between septoplasty and non‐surgical management for nasal obstruction due to a deviated nasal septum was €2227 per patient from a healthcare perspective (including direct healthcare costs) and €3288 per patient from an extended perspective (additionally including travel expenses and productivity losses due to poor health). In comparison with non‐surgical management, septoplasty needed to gain 0.11 to 0.16 QALYs or save 13 sick days for nasal obstruction. The longer septoplasty's effect lasts, the more time it will have to compensate its extra costs. Conclusion This study shows that the known cost difference between treatments can be used as the starting point to determine beneficial effects needed for cost‐effectiveness of surgical interventions. The effect required by septoplasty from a healthcare perspective seems potentially achievable, meaning that it would be useful to perform an RCT assessing the actual benefits of septoplasty.

A comparison of men and women undergoing septoplasty—the Swedish national septoplasty register

“…Given the relatively small differences in the natural distribution of septal deviations between men and women, it is surprising that several recent studies analysing predictors and outcome in septoplasty report a considerable male predominance in the septoplasty cohorts (4). Data from the Swedish National Septoplasty Register (SNSR) show that around 70% of the patients are males, which is in line with other studies (1,4,6,7). It has been proposed that men are more involved in nasal traumas related to sports activities, assaults and motor vehicle accidents and therefore experience more problems with their nasal breathing due to a nasal obstruction (8).…”

“…There were no objective data of nasal air-flow resistance or intranasal geometry, such as rhinomanometry or acoustic rhinometry available in this study. PROMS and objective measures, however, often show conflicting results ( 1 , 4 ). It is thus important to consider both PROMS and objective measures in the follow up of septoplasty surgery as partly different but complementary outcome measures.…”

“…Septoplasty is the recommended surgical intervention to relieve structural nasal obstruction due to a deviated nasal septum. The efficacy of this operation is well known from many studies using objective measurements of nasal airflow and resistance, but this has only recently been confirmed in a first randomised controlled trial compared with non-surgical treatment ( 1 , 2 ). Regarding patient reported outcome measures (PROMS), including subjective perception of nasal obstruction, the results of improvement 6–12 months after surgery vary around 70%–80% ( 3 , 4 ).…”

Septoplasty versus non-surgical management for nasal obstruction in adults with a deviated septum: economic evaluation alongside a randomized controlled trial

“…Randomized controlled trials or non-randomized comparative studies on the (cost-) effectiveness of septoplasty have not been published before [5]. Previous modeling research based on publicly available data sources demonstrated that septoplasty incurs significant additional costs compared to non-surgical management, especially considering the productivity losses due to postoperative recovery [10]. However, as effectiveness data were lacking, the relation between costs and effects of septal surgery remained unclear.…”

“…Both health-related quality of life and objective measurements of nasal airflow were found to improve after septoplasty. Nonetheless, previous modeling research demonstrated that septal surgery incurs significant additional costs compared to non-surgical management [10]. Considering the rising demand for care and growing strain on resources, it is important to weigh the benefits of an intervention against its costs, in order to justify its use to society [11].…”