Cost Utility Analysis of Fluticasone Exhalation Delivery System Versus Budesonide Nasal Irrigation for Chronic Rhinosinusitis With Nasal Polyps

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is managed after sinus surgery with topical corticosteroids. Given limited distribution of nasal steroid sprays, patients have the option of either steroid nasal irrigation (SNI) or exhalation delivery system with fluticasone (EDS-FLU). This study evaluates the cost-effectiveness of EDS-FLU compared to SNI for CRSwNP. METHODS: A cohort-style Markov decision-tree economic model with a 33-year time horizon was developed in TreeAgePro. Because EDS-FLU is not currently covered by Medicare, costs of medications were estimated using retail pricing. A willingness-to-pay threshold of $50,000/quality adjusted life year (QALY) was used to determine cost-effectiveness. One-way and probabilistic sensitivity analysis was conducted using 10,000 Monte Carlo simulations. RESULTS: EDS-FLU had an incremental benefit of 0.41 QALYs compared to SNI. In base case analysis, EDS-FLU costs $140,966.63 after the study period, whereas SNI costs $40,817.50. With an ICER of $244,185.37/QALY, SNI is the more cost-effective strategy. Probabilistic sensitivity analysis reported SNI as the cost-effective strategy in 98.50% of simulations. CONCLUSIONS: Compared to EDS-FLU, SNI is the cost-effective strategy for treating CRSwNP following FESS. Changes in drug pricing and improvements in patient selection may cause adjustments in the most cost-effective strategy for CRSwNP management.