Endoscopic Sinus Surgery More Cost-Effective than Dupilumab in Treatment of Patients with Rhinosinusitis with Nasal Polyps

What is the cost-effectiveness of dupilumab as compared to endoscopic sinus surgery (ESS) in the treatment of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) refractory to medical therapy?

BOTTOM LINE

While dupilumab and ESS may demonstrate similar clinical effectiveness, ESS remains the more cost-effective option for patients with CRSwNP refractory to medical therapy.

BACKGROUND: Dupilumab is a novel monoclonal antibody that shows promise in treating patients with CRSwNP who fail initial medical management. ESS, the mainstay therapy for CRSwNP, has been shown to be clinically effective and cost-effective when compared to long-term medical management. Data comparing the cost-effectiveness of ESS and dupilumab is scarce.

STUDY DESIGN: Cohort-style evaluation.

SETTING: Department of Otolaryngology–Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Fla.

SYNOPSIS: Researchers created a decision tree microsimulation model in which patients with CRSwNP were assigned to either dupilumab or ESS, after which they entered a Markov model specific to that treatment. Patients who entered the dupilumab arm who responded (experienced a continued clinical benefit) to treatment continued to receive the therapy; those who did not respond to treatment underwent surgery followed by maintenance treatment or revision surgery if needed. Patients who entered the surgery arm either followed maintenance treatment or underwent revision surgery if needed. Effectiveness was measured using Sino-Nasal Outcome Test scores. The average effectiveness of dupilumab and surgery, measured as quality-adjusted life-year over the 10 model years, was 1.779 and 1.526, respectively. Modeled from the payer perspective, over the 10 years, the average lifetime costs of the dupilumab and surgery were $195,164 and $20,549, respectively. Although dupilumab therapy showed somewhat greater overall effectiveness, in the long term, ESS was the more cost-effective option. Dupilumab treatment requires two-week dosing, so the chronicity of treatment, compounded with high drug pricing, creates high healthcare consumption. Study limitations included a lack of data on dupilumab application.

CITATION: Parasher AK, Gliksman M, Segarra D, et al. Economic evaluation of dupilumab versus endoscopic sinus surgery for the treatment of chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol. 2022;12:813–820.