Long‐term utility outcomes in patients undergoing endoscopic sinus surgery

Abstract

Objective To define long-term health state utility outcomes in patients undergoing endoscopic sinus surgery (ESS) for refractory chronic rhinosinusitis (CRS) Study Design Prospective, longitudinal cohort study Methods The SF-12 survey was issued to the 168 patients who were enrolled in an initial study evaluating short-term utility outcomes following ESS. SF-12 responses were converted into SF-6D utility scores using the University of Sheffield algorithm. The primary outcome was mean overall long-term utility level following ESS. Secondary outcomes evaluated annual utility level following ESS and utility outcomes for different subgroups of patients with CRS. Results A total of 83 patients provided long-term health state utility outcomes. The mean overall long-term utility level was 0.80 at a mean follow-up of 5.2 years after ESS. Compared to the baseline (0.67) and short-term follow-up (0.75) utility levels in this group, there was a significant improvement at the long-term period (p=0.002). 54% (45/83) of patients achieved long-term postoperative utility scores higher than the United States (US) norm of 0.81. There was a significant improvement in utility scores for all subsequent years after ESS compared to preoperative responses (all p<0.028). All subgroups of CRS received significant long-term utility improvements (all p<0.001), while those undergoing revision ESS demonstrated continued improvement past the short-term postoperative period. Conclusion This study has demonstrated that patients with refractory CRS achieve stable mean long-term utility levels following ESS and often return to a health state comparable to US population norms.

Efficacy of ESS in chronic rhinosinusitis with and without nasal polyposis: a Danish cohort study

“…As this study design set out to be representative of the daily clinical practice, it did not enable us to add a 1-year clinical followup. However, previous long-term studies have documented that the effects of ESS measured after 3-12 months, are likely to be sustained over a 5-year period [28,29].…”

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…75,77 In addition, cardinal symptoms 1338 and most symptoms classically ascribed to CRS 1339 substantially improve, and patient rating of health utility increases to that of the normal population after ESS. 1340 Patients undergoing revision surgery, regardless of polyp status, also experience significant improvement, though the magnitude of improvement is slightly less than primary surgery patients, likely because of a selection bias of more severe inflammatory disease in those requiring revision surgery. 77,1341,1342 Health utility measurements (how patients value their current state of health) of CRS with and without polyposis demonstrate substantial reduction in health utility comparable to those with moderate asthma, end-stage renal disease, or Parkinson's disease.…”

“…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

“…In another retrospective analysis on overall health-care utilisation, it was found that patients with CRS had an eightfold increase in their costs compared to baseline population levels, but returned to baseline 13 weeks following ESS [66]. Similarly, Rudmik and co-workers demonstrated that patients with refractory CRS return to levels of health-care utilisation similar to the US population norms following ESS [67].…”