ECONOMIC-IMPLICATIONS OF CHRONIC SINUSITIS

An approach to cost analysis useful in understanding the economic impl ications of surgical intervention on chronic sinusitis is break-even t ime analysis, The break-even time is the time until cost savings assoc iated with improved health status after surgery equal the up-front cos ts of the operation itself. Data from 100 consecutive patients undergo ing sinus operation were obtained by survey before surgery and at quar terly intervals for 1 year with statistically validated outcome measur es (Medical Outcome Study Short Form 36-item Health Survey, Chronic Si nusitis Survey), Direct and indirect costs were obtained or derived fo r this cohort. The cost of sinus medications, including over-the-count er remedies, nasal steroid sprays, and antibiotics, averaged $1220 per patient per year before surgery and $629 after surgery (p < 0.0001), which is a 48% reduction, Surgical costs averaged $6490 per patient, E conomic modeling predicted a break-even time of approximately 7 years assuming a 3% surgical revision rate per year, a 3% decrease in sickne ss-related disability,and a 5% discount rate. The model was sensitive to changes in the total cost of operation, the surgical revision rate, and the anticipated disability benefit. We conclude that significant direct and indirect medical cost savings may be achieved after surgica l intervention for chronic sinusitis and these savings eventually brea k even with the total cost of surgery itself.