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

Abstract

Background: For years, the benefits of septoplasty have been questioned. Due to the scarce and inconclusive literature, several National Health Service (NHS) Clinical Commissioning Groups in England decided to add septal surgery to their list of restricted procedures with low clinical value. Recently, evidence was obtained that septoplasty is actually more effective than non-surgical management for nasal obstruction in adults with a deviated septum. However, the relation between costs and effects of septoplasty remains unknown. Methods: We conducted an economic evaluation alongside an open, multicenter, pragmatic randomized controlled trial in two tertiary and 16 secondary referral hospitals in the Netherlands. Adults with nasal obstruction and a deviated septum were randomized to (1) septoplasty with or without concurrent turbinate surgery or (2) non-surgical management consisting of (a combination of) medical treatment and watchful waiting. Analyses were performed on an intention-to-treat basis. Single imputation nested in the bootstrap percentile method (using 5000 bootstrap replications) was performed to assess the effect of missing data. After 12 and 24 months, we assessed the incremental costs per quality-adjusted life year (QALY) gained from a healthcare and a societal perspective.

Efficacy of Septoplasty in Patients with Nasal Obstruction: A Systematic Review and Meta‐analysis

“…58 Moreover, in 2020, the same group published an economic evaluation showing that surgery would appear to be cost effective in the long term when compared to medical treatment. 59 The main strength of our study is that this is the first meta-analysis to answer the call for further research in investigating the efficacy of functional septoplasty, which has been voiced from clinical practice. However, this study is subjected to some limitations.…”

“…They concluded that septoplasty is more effective than non‐surgical management for nasal obstruction in adults with a deviated septum 58 . Moreover, in 2020, the same group published an economic evaluation showing that surgery would appear to be cost effective in the long term when compared to medical treatment 59 …”

Long‐Term Outcomes of Septoplasty With or Without Turbinoplasty: A Systematic Review

“…30 Five additional studies reported both short and long-term subjective outcomes but did not report p-values. 10,11,27,31,32…”

“…Ten studies reported patient satisfaction as a percentage of patients, 13,[33][34][35][36][37][38][39][40][41] ten studies reported subjective symptom improvement as a percentage of patients, 14,15,32,[42][43][44][45][46][47][48] and three studies reported symptom improvement defined as a "clinically significant" change in NOSE or SNOT-22 score as a percentage of patients (Table IV). 10,49,50 Of the 3,113 patients included in these 23 studies, 2,348 (75.4%) reported satisfaction and/or improvement from preoperative baseline at their latest postoperative follow-up, which averaged 27.0 months. 10,[13][14][15][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] Of these 3,11...…”

“…Many studies have shown that septoplasty with or without turbinoplasty is effective in improving symptoms of nasal obstruction, especially when compared to nonsurgical medical treatment. [8][9][10][11] However, most of these studies and nearly all current reviews focus primarily on short-term (<12 months) outcomes. Whether or not these high septoplasty success rates persist years after surgery remains unanswered, as some long-term studies suggest that patient symptoms may worsen again over time.…”