Economic evaluation of a steroid-eluting sinus implant following endoscopic sinus surgery for chronic rhinosinusitis

Objective. This study aimed to evaluate the cost-effectiveness of a mometasone steroid-eluting sinus implant compared to a nonsteroid-eluting sinus implant following endoscopic sinus surgery (ESS) for chronic rhinosinusitis. Study Design. Economic evaluation using a decision tree model. Setting. Academic and nonacademic otolaryngology practices. Subjects. Patients with refractory chronic rhinosinusitis undergoing ESS. Methods. The economic perspective was the health care third party payer. Effectiveness and probability data were obtained from a single meta-analysis of 2 randomized, double-blind, controlled trials. Costs were obtained from the Centers for Medicare & Medicaid Services database and wholesale pharmaceutical pricing. Multiple sensitivity analyses were performed including a probabilistic sensitivity analysis. Comparative treatment groups were (1) placement of the mometasone steroid-eluting sinus implant following ESS and (2) placement of a nonsteroid-eluting implant following ESS. The primary outcome was cost per postoperative intervention avoided within 60 days after ESS. Results. The mean cost for the steroid-eluting and nonsteroideluting sinus implant strategies were $1,572.91 and $365.18, respectively. The steroid-eluting strategy incremental costeffectiveness ratio was $5,489.68. The sensitivity analysis demonstrated a 74.3%, 87.2%, and 90.5% certainty that the steroideluting implant strategy is cost-effective at willingness-to-pay thresholds of $10,000, $25,000, and $50,000, respectively. Conclusion. Results from this economic evaluation suggest that placement of a mometasone steroid-eluting sinus implant into the ethmoid cavity following ESS for refractory chronic rhinosinusitis is a cost-effective intervention for preventing a postoperative intervention within 60 days after surgery.